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Case Report
 
Syphilitic paroxysmal cold hemoglobinuria associated with peripheral gangrene: A diagnostic dilemma
Segun P Adeoye1, Seema Tayal2, Apar Bains3, Prabhjot Manes2
1University of Pittsburgh Medical Center (UPMC), Horizon Hospitalist Unit, Greenville and Shenango Valley Hospitals, Pennsylvania, USA.
2Department of Family Medicine The Brooklyn Hospital Center, Brooklyn, New York. USA.
3Union Primary Care Elkton Elkton, Maryland 21921.

doi:10.5348/ijcri-201466-CR-10377

Address correspondence to:
Apar Bains
MD, MPH
191 Willoughby St, Apt 15 B
Brooklyn NY 11201
USA
Email: bainsapar@gmail.com

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How to cite this article
Adeoye SP, Tayal S, Bains A, Manes P. Syphilitic paroxysmal cold hemoglobinuria associated with peripheral gangrene: A diagnostic dilemma. International Journal of Case Reports and Images 2014;5(5):339–344.


Abstract
Introduction: Paroxysmal cold hemoglobinuria is a rare clinical entity; syphilitic association is even rarer. The lack of awareness amongst healthcare providers, and its fleeting course often mean that many a time, paroxysmal cold hemoglobinuria is not diagnosed.
Case Report: Herein, we present a case of syphilitic paroxysmal cold hemoglobinuria with peripheral gangrene that necessitated amputation. We describe the atypical presentation, emphasize or diagnostic dilemma and report our therapeutic considerations.
Conclusion: The report raises two important points (i) the lack of awareness of the clinical entity amongst healthcare providers (ii) the sub-optimal work-up done for late-onset dementia. We conclude by making the case for including the screen for syphilis in their work-up of patients presenting with aortic valvular disease, chronic dementia (especially of the early-onset type) and hemolytic anemia of the cold antibody variety.

Keywords: Syphilitic paroxysmal cold hemoglobinuria, Syphilis, Cold hemoglobinuria


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Author Contributions
Segun P Adeoye – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Seema Tayal – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Apar Bains – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Prabhjot Manes – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Segun P Adeoye et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Segun Adeoye is a Hospitalist at University of Pittsburgh Medical Centers in Greenville and Shenango Valley, Pennsylvania, USA. He earned MBBS degrees from College of Medicine of University of Lagos, Nigeria. He has published 11 research papers and peer-reviewed articles in national and international academic journals and authored a book titled "Synopsis of Medical Biochemistry- A MediLag Experience". His research interests include primary care, preventive medicine, hospital medicine, complementary and integrative medicine. He is currently a Fellow at the University of Arizona Complimentary and Integrative Medicine Program. He intends to pursue a PhD in bio-informatics.



Seema Tayal is Chief Resident of quality improvement at The Brooklyn Hospital Center, Brooklyn, New York, USA. She earned the undergraduate degree MBBS from Baba Farid University of Health Sciences, Punjab, India and postgraduate degree from MD from The Brooklyn Hospital Center, Brooklyn, New York, USA. She has also earned MBA in Health Care Management from University of Massachusetts, Boston, USA. She has published three research papers in national and international academic journals. Her research interests include primary care, preventive medicine and health care quality improvement.



Apar Bains is a Primary Care Physician at Union Primary Care, Union Hospital of Cecil County, Elkton, MD, USA. He earned the undergraduate degree MBBS from Baba Farid University of Health Sciences, Punjab, India and postgraduate degree from MD from The Brooklyn Hospital Center, Brooklyn, NY, USA. He has also earned degree of MPH (epidemiology) from University of Massachusetts, Amherst, Massachusetts, USA. He has published 4 research papers in national and international academic journals. His research interests include primary care, health care quality improvement.



Prabhjot Manes is a Resident at The Brooklyn Hospital Center, Brooklyn, New York, USA. She earned the undergraduate degree MBBS from Baba Farid University of Health Sciences, Punjab, India and postgraduate degree from MD from The Brooklyn Hospital Center, Brooklyn, New York, USA.