# A case of paroxysmal cold hemoglobinuria complicated by latent syphilis

## TL;DR

An elderly man with jaundice was found to have both latent syphilis and paroxysmal cold hemoglobinuria, which improved with treatment.

## Contribution

This case highlights the rare co-occurrence of latent syphilis and PCH, emphasizing the importance of comprehensive diagnosis and treatment.

## Key findings

- Latent syphilis was diagnosed through positive serology and improved with antibiotic treatment.
- Autoimmune hemolytic anemia was confirmed by a positive direct Coombs test.
- Paroxysmal cold hemoglobinuria was diagnosed via a positive Donath-Landsteiner test and improved with cold avoidance.

## Abstract

An 80-year-old man presented in December with the main complaint of jaundice. Blood tests revealed hemolytic anemia and renal dysfunction. Positive syphilis serology results led to a diagnosis of untreated latent syphilis. A positive direct Coombs test led to a diagnosis of autoimmune hemolytic anemia (AIHA). Antibiotics were started for the syphilis, with improvement in the anemia and renal dysfunction observed. However, paroxysmal intravascular hemolysis occurred after his discharge. Based on a positive Donath-Landsteiner (D-L) test, paroxysmal cold hemoglobinuria (PCH) diagnosis was made. The hemolytic anemia improved after further treatment for syphilis, and further avoiding exposure to cold.