a Tdp rhythm. The patient passed away shortly after being placed on a do not resuscitate status.
Managing QTc prolongation in HIV patients with opportunistic infections poses significant clinical challenges, particularly when balancing the risks of life-saving antifungal therapies and cardiac safety. This study serves as a reminder of the ultimately lethal risk of QTc prolonging agents, in this case fluconazole. This case also underscores the importance of a multidisciplinary approach to optimize outcomes in complex patients with infectious and cardiac complications.
Discussion: Long-term use of medications used to treat fungal infections, like fluconazole, can exacerbate QTc prolongation, making it difficult to balance infection control and cardiac safety. Furthermore, several studies suggest that prolonged QTc intervals are significantly more prevalent in HIV patients compared to non-HIV patients.
THE GREAT IMITATOR: NEUROSYPHILIS MIMICKING GIANT CELL ARTERITIS Vincent Pham, Neha Baplata, Patricia Otero Valdez, Tom Eggers, Harshita Rachalmallu, Brett Wilkinson; Tulane University School of Medicine, New Orleans, LA.
Introduction: Neurosyphilis can have a diverse array of presentations and symptoms. The low incidence of neurosyphilis creates a diagnostic challenge with how it can mimic other pathologies. Case Description: A 64-year-old man with diabetes mellitus, hypertension, and stage IV chronic kidney disease presented after noticing decreased vision and blurriness in his right eye for the past week. He endorsed a constant headache, but otherwise denied sudden vision loss or jaw pain. Ophthalmology evaluation revealed significant hypertensive retinopathy, but no acute damage to the optic nerve. Non-contrast CT scan showed no acute findings. Since no obvious source of vision loss was ascertained, further workup was pursued. His labs revealed an elevated erythrocyte sedimentation rate and C reactive protein, prompting concern for giant cell arteritis (GCA). He was started on high dose intravenous (IV) steroids, and experienced mild vision improvement. The patient declined a temporal artery biopsy. Due to the abnormal presentation, syphilis labs were collected. The patient completed his IV steroid treatment and was discharged with high-dose prednisone to continue treatment for presumptive GCA. A week later, his parpid plasma
regain (RPR) titers resulted as 1:128 with a positive fluorescent treponemal antibody absorption test (FTA-ABS). The patient returned to the hospital where he endorsed vision improvement but still had some blurry vision. He was started on a 14-day course of IV penicillin G due to suspected neurosyphilis per recommendations from Infectious Disease but also remained on steroids. Repeat testing confirmed the diagnosis of syphilis. After the addition of the penicillin, he experienced rapid improvement of his vision back to his baseline within 2 days. The patient was symptom free and was discharged to complete his antibiotic treatment at home. Discussion: This case illustrates how neurosyphilis can present with non-specific symptoms and can mimic other conditions such as GCA. Neurosyphilis should be suspected in cases of atypical presentations of neurologic defects, especially when the patient has risk factors for being immunocompromised, such as chronic kidney disease and diabetes. Early recognition of neurosyphilis is important for urgent treatment with penicillin to prevent further manifestations of tabes dorsalis or meningoencephalitis.
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