RT Book, Section
A1 Usatine, Richard P.
A1 Chumley, Heidi
A2 Usatine, Richard P.
A2 Sabella, Camille
A2 Smith, Mindy Ann
A2 Mayeaux, E.J.
A2 Chumley, Heidi S.
A2 Appachi, Elumalai
SR Print(0)
ID 1114878604
T1 Syphilis
T2 The Color Atlas of Pediatrics
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-176701-9
LK accesspediatrics.mhmedical.com/content.aspx?aid=1114878604
RD 2024/04/25
AB A  young  woman  presents  to  the  office  with  a  total  body  rash  for  one  week  (Figure  181-1).  She  denies  other  symptoms  and  the  rash  does  not  itch.  Upon  examination,  tattoos  on  her  hands  are  visible  and  she  does  admit  to  experimenting  with  crack  and  IV  heroine.  The  physician  suspects  that  she  may  have  secondary  syphilis  and  she  admits  to  many  sexual  partners  especially  while  using  drugs.  She  is  given  a  shot  of  2.4  million  units  of  benzathine  penicillin  IM  in  the  office  and  her  blood  is  drawn  for  an  RPR  and  an  HIV  test.  The  RPR  and  HIV  tests  come  back  positive  along  with  a  treponemal  specific  confirmatory  test.  The  patient  is  called  to  return  to  the  office  for  some  serious  counseling  and  a  referral  to  an  infectious  disease  specialist.  The  ID  specialist  is  called  on  the  phone  to  see  if  he  wants  to  admit  her  for  a  lumbar  puncture  or  if  he  will  do  this  as  an  outpatient.  She  needs  investigation  for  neurosyphilis  due  to  her  positive  HIV  status.