A 30-year-old male patient, Hatiano, with no clinical compl | Figure 1

Moaby

Licensed Vocational Nurse

Patient Case Summary

A 30-year-old male patient, Hatiano, with no clinical complaints, in a routine appointment, performed a treponemal positive test, VDRL: 1/64. After the second dose of Penicilina Benzatina 2,400 million IU, appears in the unit with such reactions on the skin, as shown in the photo. Do you know the name of this reaction and in what phase of Syphilis? What is your conduct?

Case Discussions

Patient with history of severe mental illness (unpredictable mood, dementia-like symptoms) presents to PCP with no abnormal symptoms for routine physical and testing with STI screening. All tests came back as normal for blood work and negative for STI. 1 week later, the lab happened to be attempting validation for EIA Syphillus via analyzer. Patient's blood was pulled as a "known negative." Via this method, the patient presented as a strong positive on 10/10 repetitions. To rule out the possibility of a false positive via misperforming EIA, RPR was retested by 3 separate personnel, resulting in a confirmed negative screen and ruling out lab procedural error. A confirmatory TPPA was performed afterward to confirm true negative. This, however, resulted in a positive reaction, confirming the reaction from the validation studies. This false negative RPR was later confirmed to be due to tertiary syphillus. It seems that all the stars aligned for the patient in order to finally reach a diagnosis. Sadly, any damage done up to this point is beyond reversible.

Additional Cases

Case: rpr and tpha positive. HIV negative. Sharing is caring! #lovederm

Case: Secondary syphilis in untreated HIV(+) patient.

Case: A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Case: A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Case: A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Case: patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?