Thread by @DMalebranche

I had to send a 26 year old patient to the hospital yesterday after a telehealth visit.

He is living with #HIV

Had lymphoma 5 years ago requiring surgery and chemo

Has syphilis titers that have stayed elevated for 2 years, even after outpatient penicillin treatment.
1/

Now is having fevers, nightsweats, headaches, blurry vision, and unintentional 10 pound weight loss in two weeks.

His T cell count dropped from 200 to 100, even though he is taking his HIV meds and has an undetectable viral load.

I gave him my cell number just in case.
2/

The admitting hospitalist reached out to me this morning.

Him: "Your patient gave me your number. I guess he wanted me to call you with updates."

Me: "No, I gave him my cell phone so you could call me if you needed more information for your clinical decision-making."
3/

He proceeded to tell me he thought our patient's symptoms may be due to the 1st #COVID19 vaccine he received a few days ago.

Also that his blood tests were positive for mononucleosis.

Me: "Antigen or antibodies?"
Him: "Antibodies."
Me: "IgM or IgG?"
Him: "I'm not sure."
4/

Me: "So all you know is that he may have been exposed to mono in the past."
Him: "Correct."

He then mentioned getting a full body CT scan to check for lymphoma.

Good idea.

Him: "And we will get ophthalmology to come look at him, but that may not be til tomorrow."
5/

Me: *silence*
Him: "... and, I mean, I guess we could do a spinal tap."
Me: "That would be clinically appropriate, yes."

I told him that I've seen 2 cases of ocular/neuro syphilis in young men living with HIV in the past 2 months.

Folks can go blind if not treated early.
6/

Getting this clinician to follow recommended guidelines felt like pulling teeth.

I know many medical professionals don't value Black life.

I do.

Laziness and racial bias can cloud sound clinical judgment.

Don't let it.

You might save someone's life.
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