Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.21.7 (plasmin)
 9,023 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 54-year-old African-American male was hospitalized with a left "cerebrovascular accident," altered mental status, agitation, rhabdomyolysis, and hypernatremia. Laboratory tests found cocaine in his system and a positive RPR (rapid plasmin reagin test). A CAT (computed axial tomography) scan without contrast taken 8 days prior to his death showed a left middle cerebral artery infarct, with edema and mass effect, and a 1-cm midline shift to the right. He underwent symptomatic treatment, eventually suffered cardiopulmonary arrest and multiorgan failure, and expired 8 days after admission. The left cerebral lesion diagnosed clinically as a cerebral infarct was actually determined to be a syphilitic gumma on postmortem neuropathologic examination. Neurosyphilis, although rare, should be considered in the differential diagnosis of space-occupying lesions in the brain because cases of syphilis continue to occur both sporadically and as an opportunistic infection associated with acquired immunodeficiency syndrome (AIDS) and because neurosyphilis is treatable.
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PMID:Unsuspected central nervous system gummas in a case of "cerebral infarct" associated with cocaine use. 1772 Nov 67

This case describes an emergency department (ED) presentation of ocular syphilis in a human immunodeficiency virus (HIV) infected patient. This is an unusual presentation of syphilis and one that emergency physicians should be aware of. The prevalence of syphilis has reached epidemic proportions since 2001 with occurrences primarily among men who have sex with men (MSM). This is a case of a 24-year-old male who presented to our ED with bilateral painless vision loss. The patient's history and ED workup were notable for MSM, positive rapid plasmin reagin (RPR) and HIV tests and fundus exam consistent with ocular syphilis, specifically uveitis. Ocular manifestations of syphilis can present at any stage of syphilis. The 2010 Centers for Disease Control and Prevention guidelines now recommend that ocular syphilis be treated as neurosyphilis regardless of the lumbar puncture results. There is a paucity of emergency medicine literature on ocular syphilis. For emergency physicians it is important to be aware of iritis, uveitis, or chorioretinitis as ocular manifestations of neurosyphilis especially in this high-risk population and to obtain RPR and HIV tests in the ED to facilitate early diagnosis, and treatment and to prevent irreversible vision loss.
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PMID:Don't Forget What You Can't See: A Case of Ocular Syphilis. 2742 2