Location
Chamberlain Student Center
Document Type
Poster
College
Rowan-Virtua School of Osteopathic Medicine
Event Website
https://research.rowan.edu/rowan-research-days-2024.html
Start Date
26-3-2024 12:00 PM
End Date
26-3-2024 3:00 PM
Abstract
Introduction: Syphilis screening, a common medical test in the US, is recommended annually in sexually active women younger than 25, annually for women older than 25, and annually for men(1). Standard tests include rapid reagin tests and Venereal Disease Research Laboratory tests, which react to membrane antigens of Treponema pallidum(2). Case reports of patients with autoimmune conditions have been described (3) but rarely considered in clinical practice. Additionally, patients may be underdiagnosed with autoimmune conditions with clinically relevant antibodies (4). Here, we describe one such case where a patient received delay in care prior to referral to our service. Case Presentation: A 52-year-old woman presented with chief complaint of lower extremity biopsy-proven leukocytoclastic vasculitis with joint pain, swelling, and new ulcers; with syphilis titer of 1:8 on RPR but denies sexual activity or use of antimicrobials within the last year. Current diagnoses include obsessive-compulsive disorder and antiphospholipid syndrome. Her medication history included a short, subtherapeutic dose of 100mg of minocycline; and prednisone, naproxen, famotidine, ibuprofen, olmesartan, amlodipine, hydrochlorothiazide, prednisone, pentoxifylline, fluvoxamine maleate, and albuterol. Physical exam demonstrated a lace-like rash and narrowing on upper and lower extremities with ulceration and substantial edema. Subsequently, she also demonstrated a substantial amount of oral candidiasis. Upon further testing, her eosinophil count was 0, CRP 3 mg/L, HIV negative, syphilis antibodies negative, and RPR remained positive. Her symptoms improved after discontinuation of fluvoxamine and prednisone initiation. Conclusion: Antiphospholipid syndrome, lymphocytoclastic vasculitis, and fluvoxamine may have contributed to this patient’s false positive RPR for syphilis, as well as a delay in treatment for her vasculitis of several months due to pursuit of syphilis workup and treatment. The prevalence of antiphospholipid syndrome has been estimated at 1/2000(4) and should be considered in the workup of patients presenting with high RPR titer and no clear exposure history.
Included in
The Imitation Game: Drug Reaction Presenting as Autoimmunity Presenting as Syphilis
Chamberlain Student Center
Introduction: Syphilis screening, a common medical test in the US, is recommended annually in sexually active women younger than 25, annually for women older than 25, and annually for men(1). Standard tests include rapid reagin tests and Venereal Disease Research Laboratory tests, which react to membrane antigens of Treponema pallidum(2). Case reports of patients with autoimmune conditions have been described (3) but rarely considered in clinical practice. Additionally, patients may be underdiagnosed with autoimmune conditions with clinically relevant antibodies (4). Here, we describe one such case where a patient received delay in care prior to referral to our service. Case Presentation: A 52-year-old woman presented with chief complaint of lower extremity biopsy-proven leukocytoclastic vasculitis with joint pain, swelling, and new ulcers; with syphilis titer of 1:8 on RPR but denies sexual activity or use of antimicrobials within the last year. Current diagnoses include obsessive-compulsive disorder and antiphospholipid syndrome. Her medication history included a short, subtherapeutic dose of 100mg of minocycline; and prednisone, naproxen, famotidine, ibuprofen, olmesartan, amlodipine, hydrochlorothiazide, prednisone, pentoxifylline, fluvoxamine maleate, and albuterol. Physical exam demonstrated a lace-like rash and narrowing on upper and lower extremities with ulceration and substantial edema. Subsequently, she also demonstrated a substantial amount of oral candidiasis. Upon further testing, her eosinophil count was 0, CRP 3 mg/L, HIV negative, syphilis antibodies negative, and RPR remained positive. Her symptoms improved after discontinuation of fluvoxamine and prednisone initiation. Conclusion: Antiphospholipid syndrome, lymphocytoclastic vasculitis, and fluvoxamine may have contributed to this patient’s false positive RPR for syphilis, as well as a delay in treatment for her vasculitis of several months due to pursuit of syphilis workup and treatment. The prevalence of antiphospholipid syndrome has been estimated at 1/2000(4) and should be considered in the workup of patients presenting with high RPR titer and no clear exposure history.
https://rdw.rowan.edu/grad_student_symposium/2024/mar26/1