Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature

Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of “malignant” syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering

Supplementary materials: Impact of perioperative chemotherapy on survival outcomes among patients with metastatic colorectal cancer to the liver

These are peer-reviewed supplementary materials for the article 'Impact of perioperative chemotherapy on survival outcomes among patients with metastatic colorectal cancer to the liver' published in the Journal of Comparative Effectiveness Research.Supplementary figure A: Median overall survival in the whole cohort according to the treatment modality after propensity score matching.Supplementary figure B: Overall survival according to the treatment modality after excluding patients with 90-day mortality of most definitive primary site surgery after propensity score matching.Supplementary figure C: Median overall survival comparison between single agent and multiagent chemotherapy after propensity score matching.Supplementary figure D: Median overall survival comparison between adjuvant and neoadjuvant chemotherapy after propensity score matching.Supplementary figure E: Median overall survival according to the treatment modality in (A) MSI-H and (B) MSI-L.Supplementary figure F: Median overall survival comparison between single agent and multiagent chemotherapy in (A) MSI-H and (B) MSI-L.Supplementary figure G: Median overall survival comparison between adjuvant and neoadjuvant chemotherapy in (A) MSI-H and (B) MSI-L.Supplementary Table A: Baseline characteristics of metastatic CRC patients with liver metastases according to the treatment modality after propensity score matching.Supplementary Table B: Baseline characteristics of metastatic CRC patients with liver metastases excluding patients with 90-day mortality of most definitive primary site surgery according to the treatment modality after propensity score matching.</p

A Curious Case of Proximal Muscle Weakness with Eosinophilic Polymyositis

Eosinophilic polymyositis (EPM) is part of a rare disorder, eosinophilic myopathies (EM), which is a form of polymyositis characterized by the presence of eosinophils in muscle biopsy sections and occasionally blood eosinophilia. Herein, we are presenting an interesting case of eosinophilic polymyositis presenting with muscle pain with no other organ systems involved