Uninsured, Unhoused, and Reinfected: Why the Scourge of Congenital Syphilis Persists: A Case Report

A 32-year-old African American woman with a history of latent syphilis, diabetes mellitus, previous intravenous drug use, and tobacco abuse presented from an outside hospital with symptoms of shortness of breath and a new left lung consolidation with left pleural effusion. Bronchoscopy revealed acute necrotizing pneumonia with anaerobic culture growing Prevotella buccae. After adjusting antibiotics, the repeat computed tomography showed minimal improvement. The lack of progress and her social factors led to the decision for surgical intervention. Cardiothoracic surgery was performed, and the surgical findings were consistent with acute necrotizing pneumonia and abscess consistent with empyema. Abscess cultures were positive for Candida albicans and Methicillin-resistant Staphylococcus aureus (MRSA). During this hospitalization, the patient was found to have a Rapid Plasma Reagin of 1:256. The patient has a history of syphilis that resulted in the birth of a baby with congenital syphilis. The patient reports several health-related social needs that stem from unfavorable social determinants of health (SDOH), including limited access to healthcare and housing insecurity. Research shows that unsatisfied social needs can contribute to adverse health outcomes, which is reflected in this patient’s extended hospital stay and prolonged history of syphilis. Providing healthcare workers with the resources to address these social needs, especially in emergency departments, can help improve health outcomes among Mississippians.