We present a case of a patient with acute colonic pseudo obstruction (Ogilvie’s Syndrome) in a 63-year-old Hispanic male with multiple co morbidities, sent from the Nursing Home for evaluation of progressive abdominal distention. Clinical examination and diagnostic workup confirmed massive colonic dilatation, without mechanical obstruction.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comSyphilitic paroxysmal cold hemoglobinuria associated with peripheral gangrene: A diagnostic dilemma Segun P Adeoye, Seema Tayal, Apar Bains, Prabhjot Manes 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.