Villous lymphocytes observed in the cerebrospinal fluid of a patient with asymptomatic neurosyphilis

Abstract

A 53-year-old man was referred to our department (Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan) by his previous doctor for the evaluation of an episode of syncope. As clinical, imaging and physiological function examinations revealed no abnormalities, we could not identify the cause of his syncope. However, he was diagnosed incidentally as having asymptomatic neurosyphilis based on cerebrospinal fluid (CSF) pleocytosis (94 leukocytes/mm3 with 95% lymphocytes) and elevated protein, in addition to reactive serum and CSF treponemal tests. The antibody test for human immunodeficiency virus was negative. Immunostaining of the cytological specimen showed that the proportions of T cells, B cells, and dendritic cells in the CSF were approximately 70%, 30% and 0%, respectively. When we examined the CSF using a scanning electron microscope, we observed abundant villous lymphocytes that obviously showed long processes (Fig. 1a,b). Villous lymphocytes have been observed in the serum of patients with hairy cell leukemia, splenic marginal zone lymphoma and hyper-reactive malarial splenomegaly.1 Bates et al. suggest that, in hyperreactive malarial splenomegaly, a villous subset of B-lymphocytes is overproduced as a result of excessive stimulation by malaria antigen. In contrast, villous lymphocytes in the CSF have been described only in patients with splenic marginal zone lymphoma.2 Further analysis is required to clarify whether villous lymphocytes in the CSF is specific to neurosyphilis. The authors declare no conflict of interest.