Altered Mental Status- a surprise diagnosis

6 Recently had a 80+ year old man admitted for AMS (altered mental status) and pneumonia. No big whoop. He was given a complete workup and started on antibiotics. Elevated WBC, neg CXR, cat scans of chest and head, and neg urine (first thing we thought of). This guy was off his rocker, talking nonsense, wouldn't stay in bed, more or less out of control. We had gotten a sitter and had to resort to restraints to keep him safe. He had been living with family and they stated that his deterioration had come on fairly suddenly. The patient got several consults and finally a neurologist came up with the idea for a syphilis test. Bingo! This poor guy had probably had syphilis for a great deal of his life and now was in the tertiary (neuro) stage. Was placed on high dose IV penicillin and within 3 days his mental status made a rapid turn around. Felt good to have seen a real 'cure' although some of his dementia will never go away.
I haven't seen a case of this before, anyone else have surprise diagnosis story to share?
Very interesting...many people are not aware that a few states and Puerto Rico still require blood testing for a marriage license (it use to be all states). The required blood test is/was for syphilis and rubella. Apparently, in the 20' and 30's syphilis was quite common, especially in the big cities. I think the reasoning was that instead of your partner giving you syphilis when you got married (back than many people didn't have sex until they were married, and living together wasn't as common as it is today) that the partner of the couple could be treated prior to marriage or during, or maybe both of them.It is touted as having a huge effect on the fall of syphilis in America. I don't know why rubella was included but some states even test for other things these days as well.Also, everyone knows that Al Capone died of complications from syphilis. It is also believed that George Washington, Cortes, Hitler, Mussolini, and Ivan the Terrible suffered from syphilis though, it can't be proven.

Quote from tyvinAlso, everyone knows that Al Capone died of complications from syphilis. It is also believed that George Washington, Cortes, Hitler, Mussolini, and Ivan the Terrible suffered from syphilis though, it can't be proven.

I thought once it reached the neuro stage it was untreatable? Then again, I am by no means an expert on syphilis lol.

Quote from SnowballDVMDon't forget Idi Amin Dada, one of the most brutal dictators and mass murderers in history. Some of his mental instability may have been due to untreated syphilis, although he was, at bottom, a truly evil human being.

Quote from tyvinVery interesting...many people are not aware that a few states and Puerto Rico still require blood testing for a marriage license (it use to be all states). The required blood test is/was for syphilis and rubella. Apparently, in the 20' and 30's syphilis was quite common, especially in the big cities. I

Eh? We rule out syphilis pretty commonly with AMS and older patients. I am surprised it took a neurologist to figure that one out.

Quote from Christy1019I thought once it reached the neuro stage it was untreatable? Then again, I am by no means an expert on syphilis lol.

It is touted as having a huge effect on the fall of syphilis in America. I don't know why rubella was included but some states even test for other things these days as well.This is the info I found re: testing for rubella, remember this was back before the vaccination for it came about, so it would make sense to delay a marriage license in order to prevent a new wife from getting pregnant and possibly causing the following:Rubella can cause congenital rubella syndrome in the newborn. The syndrome (CRS) follows intrauterine infection by the rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects. It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester. CRS is the main reason a vaccine for rubella was developed.Many mothers who contract rubella within the first critical trimester either have a miscarriage or a still born baby. If the baby survives the infection, it can be born with severe heart disorders (Patent ductus arteriosis being the most common), blindness, deafness, or other life-threatening organ disorders. The skin manifestations are called "blueberry muffin lesions".

It use to be that every hospital admission was tested for syphyllis, there was an "admission panel" that was done on every single admission. Sometimes I feel we should still include this type of testing. It might eliminate some of the second guessing that is done for diagnosis and treatments.

Had a 30 something year d patient at our psych hospital last month with mental status changes also had lesions that his pcp was telling him was eczema or something like that. Ended up being syphlis transferred him out for iv abx.

Quote from firstinfamilyIt use to be that every hospital admission was tested for syphyllis, there was an "admission panel" that was done on every single admission. Sometimes I feel we should still include this type of testing. It might eliminate some of the second guessing that is done for diagnosis and treatments.

I have to say I immediately thought UTI as well. This has reminded me to not forget those less common dieases. I don't currently treat many elderly patients, but this could apply to even our younger populations. Thanks for the reminder.