In patients with acute psychosis, assessing the physical condition can make doctors safer

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The patient, a 53-year-old male with unknown medical history, was admitted to the emergency department
due to aggravated delusions at home.
Emergency department evaluation shows that the patient has impaired orientation and cannot provide any specific information about the current illness; Extreme agitation and inability to cooperate with systematic physical examination
.

On a rapid assessment of physical condition, 2 to 3 cm brown round spots on the palms, soles of the feet, and genitals, as well as papules with scaly edges (Figs.
1 and 2).

Provisional diagnosis of syphilis, venereal disease research laboratory test (VDRL, for the detection of treponema pallidum) titer 1:64, confirmed syphilis
.
Lumbar puncture shows cerebrospinal fluid VDRL titer 1:32
.
The patient also tested positive for HIV, with a CD4 count of only 22/^mm3
.

After 2 weeks of treatment with penicillin, the patient's mental status improved
significantly.

Fig.
1 Palmar lesions

Fig.
2 Plantar lesions

Clinical implications

The clinical manifestations of syphilis are complex and often confused
with a variety of disorders.
Syphilis can affect the central nervous system at any stage, and in addition to the classic neurologic manifestations, various psychiatric symptoms such as psychotic symptoms, personality changes, delirium, dementia, etc
.
can occur.
Patients with secondary syphilis may have syphilis eruption on the palms and soles of the feet, usually without obvious itching, and may be accompanied by systemic symptoms such as fever, lymphadenopathy, hepatitis, nephritis, etc
.

Syphilis has made a comeback in recent years — the number of syphilis patients in the United States increased by 81 percent
between 2014 and 2018.
For the purpose of improving the quality of care and occupational protection, it is necessary for psychiatrists to understand the clinical manifestations of syphilis, including noting certain unusual skin lesions
.
In this case, the patient presented with acute psychotic symptoms, severe agitation, and no medical history information for reference; In this case, copper-colored spots on the patient's palms provide clues
to the diagnosis.

The case was published online on 5 September in Bipolar Disord.

。

Bibliography: Khanna U, Singh K.
Acute onset psychosis - the diagnosis lies in your 'hands'.
Bipolar Disord.
2022 Sep 5.
doi: 10.
1111/bdi.
13253.
Epub ahead of print.
PMID: 36064205.