PAROXYSMAL cold hemoglobinuria due to destruction of red cells has been regarded as a troublesome though nonfatal result of syphilis. Its rarity is reflected in the report of Thurmon and Blain, who noted its occurrence in 1 of 17,300 patients admitted to the Massachusetts General Hospital.1 While late congenital syphilis claims the larger number of victims, acquired syphilis in the tertiary stage accounts for a noteworthy fraction of the cases.
The clinical syndrome may be suspected when malaise, myalgia, headache and abdominal cramps are climaxed by a severe shaking chill reminiscent of a malarial rigor occurring from several minutes to hours after exposure to cold. Fever usually follows these events and lasts for an hour or two. When intravascular hemolysis is sufficiently severe, free hemoglobin traverses the glomerular filter and appears in the urine for a variable length of time depending on the severity of the hemolytic episode. Persisting