Back in the saddle

It is good to be back in action. I worked yesterday and today and saw all kinds of crazy pathology in the emergency department. I walked into the emergency department and felt like I was at home. It is where I belong.

Today I had a patient that was complaining of a strange rash on his palms of his hands and soles of his feet. There are not a lot of diseases that manifest with this kind of rash. Usually it is either Rocky Mountain Spotted Fever or Syphilis. Sometimes scabies can present with marks on the palms but usually scabies presents in the webs of the fingers and toes. I worked the patient up and figured that it was pretty certain he had syphilis.

I ran a couple of syphilis tests and sure enough they all came back positive. We do not see a lot of syphilis anymore because of active use of antibiotics. If we see syphilis at all it usually is primary syphilis which presents as a lesion on the genitals. If the patient goes untreated they can progress to secondary syphilis which presents as a rash, often on the palms and soles. If secondary syphilis goes untreated it can ultimately lead to tertiary syphilis which presents with neurological signs and the patient can go crazy. It is almost unheard of in the modern world to see tertiary syphilis but I imagine it still occurs in certain populations. Even secondary syphilis is fairly rare.

Given the population I am seeing in this emergency department I will see all kinds of rare and weird pathology.