As it turns out, my liver failure patient did have syphilis (FTA-Ab reactive and RPR reactive). It's hard to say when he got it, since he's asymptomatic. Normally one would do an LP on him to check his CSF for syphilis (distinguish between secondary and neurosyphilis), but given his crappy coagulopathy (elevated PT, PTT, and INR) Dr. H, the ID specialist (and program director for the IM residency program here), decided to treat him empirically for neurosyphilis with large amounts of Penicillin G right off the bat. Probably a good move, except that until he won't be a good candidate for liver transplant until he's syphilis free. Neurosyphilis requires 2 weeks of treatment, so he'll probably be in the hospital for a long time. When I voiced my dismay about this, Patel said that I'll be gone by the time he leaves the hospital. I know...but I'll still wonder.
Jacob's team had an interesting case to present at morning report today; a 31 year old Hispanic male presented at the ER after a 12+ hr history of ascending paralysis with total weakness and loss of sensation in the LEs. Many people immediately thought it was Guillain-Barre, except that he had no recent illnesses and this weakness had happened previously at least six times, just not this bad. Further workup revealed a potassium of 1.6 (what is it with these patients who show up with hypokalemia?) and an undetectable TSH. This patient's problem was hyperthyroidism, and it was interesting b/c he didn't have an enlarged thyroid. Then the attendings began talking about radioablation vs PTU treatment, and as a result they spent 50 min on the same case. Wow. My team never saw anything that interesting.
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