Syphilitic paroxysmal cold hemoglobinuria associated with peripheral gangrene: A diagnostic dilemma

Abstract

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.

Applying Donath–Landsteiner test for the diagnosis of paroxysmal cold hemoglobinuria

“…[ 7 8 9 ] The disease usually presents 2–3 weeks' postinfection (viral or bacterial) with upper respiratory tract and gastrointestinal symptoms along with PCH. [ 6 10 11 ] In the present case, the patient was an elderly male with a recent history of viral infection followed by the onset of signs and symptoms of hemolysis.…”