Today I had a patient who was a little…off. She couldn’t tell me what year it is. She didn’t even know how to count backwards from 10.
I thought to myself, “She’s 70. Maybe there’s a history of cognitive decline?”
So while she sat and wondered about which day of the week it is, I quickly looked through her chart. But I found nothing. Nothing about memory lapses. Nothing about disorientation. Nothing about short-term memory issues. Nothing.
I preceded to do a full head-to-toe physical. When all I had left to do was the feet, I hesitated. I usually don’t skip the feet. But for this poor woman who sat there mumbling to herself and nodding off, I wondered if I should make an exception. The woman had enough trouble getting out of a chair, let alone pulling on socks and lacing her shoes.
But I knelt down and placed my hands on her shoes. “Ma’am, is it okay if I take off your shoes and check the bloodflow in your feet?”
She nodded and returned to mumbling to herself.
After I got the laces undone and the shoes off, I carefully pulled back the socks.
Then when I examined the soles of her feet, I found this:
Few rashes appear on the soles of the feet. Syphilis is one of them.
Syphilis can lie dormant for decades. Sometimes when it reappears, it can affect the eyes (occular syphilis). Other times, it can affect the brain (neurosyphilis), leading to dementia and behavioral disturbances.
I helped the woman put on her socks, and I tied her shoelaces. Then I left the room and reported to my preceptor. Once I mentioned the sudden cognitive decline and rash on the feet, my preceptor immediately searched the patient’s records at all local hospitals for bloodwork.
Then we found it. A positive RPR dating back a few decades, indicating that at some point the woman tested positive for syphilis. Looking through her records, she never received treatment.
We spent most of the following hour scrambling for an emergency infectious disease consult, and it did create some chaos for the remainder of our scheduled patients. But we managed, and now the poor woman is receiving treatment.