Neurosyphilis: an old and new disease

Abstract

The incidence of Syphilis decreased in the late 90s, reaching its lowest levels in 2000. However, cases are increasing annually, suggesting a greater circulation of treponema. Objective: Describe two cases with different presentations of neurosyphilis. Case 1: Male, 41-yo, diagnosed with HIV. In April 2014, he presented right-side hemiparesis which he reported to be due to ischemic etiology. Patient didn´t continue attendance. On admission, in May 2015, he kept complete and disproportionate right-side hemiparesis. CT scan of June 2015 showed a left frontoparietal hypodensity lesion in the middle cerebral artery region of ischemic character, without expansive effect or enhancement by contrast. CT brain angiography and echocardiography didn´t show alterations. Patient had negative treponemic tests in 2009. In 2012, VDRL 1/4 with negative TPHA, without treatment. In 2015, VDRL 1/128 and TPHA reactive. The cerebrospinal fluid showed VDRL 1/32. Patient started treatment with crystalline penicillin. Case 2: Male, 37-yo, without any known comorbidity, admitted in the emergency room complaining of acute blurred and doubled vision of sudden onset. Furthermore, he presented a two-month history of ulcerated genital lesions. On examination: bilateral optical papillitis with no other alterations. HIV non-reactive. Serum VDRL: 1/256,positive blood TPHA and VDRL: ½ in the cerebrospinal fluid, among other modifications. The patient also received crystalline penicillin. Early diagnosis and treatment of neuro-syphilitic ischemic stroke or ocular manifestations of neurosyphilis are crucial to a favorable prognosis. Syphilis continues to present itself as a silent disease and therefore cases are still not diagnosed and treated properly.