Cases Of Neurosyphilis Research Articles

Uncommon Neurosyphilis: Subacute Meningomyelitis with Distinctive “Candle Guttering Appearance”

AbstractIn this article, we presented an exceedingly rare clinical case of neurosyphilis, radiological revealed a distinctive “candle guttering appearance.” Posttreatment for syphilis, both clinical symptoms and radiological markers showed complete resolution.

18 F-THK5351 PET Is Superior to Conventional MRI in Identifying Inflammatory Lesions by Imaging Astrogliosis in 2 Cases of Neurosyphilis.

18 F-labeled THK5351 PET can visualize ongoing astrogliosis by estimating monoamine oxidase B levels and can be used as a neuroinflammation marker for identifying inflammatory lesions by imaging astrogliosis. Assessment of its performance is of interest, especially when compared with conventional MRI. Here, we present 2 cases of neurosyphilis, in which 18 F-THK5351 PET identified inflammatory lesions by imaging astrogliosis, whereas MRI had difficulty detecting the lesions. Hence, this study suggests that 18 F-THK5351 PET is superior to conventional MRI in identifying inflammatory lesions and that this feature of 18 F-THK5351 can provide insights into the pathophysiology of neurosyphilis in living patients.

8386 The Evolving Face of The Great Masquerader - Panhypopituitarism Associated with Neurosyphilis

Abstract Disclosure: M. Yabe: None. Z. Lin: None. F. Joseph: None. G. Philip: None. R. Silver: None. L. Callejas: None. J. Giunta: None. Untreated syphilis is on the rise in the United States. The CDC reported syphilis cases in newborns have increased 10-fold over a decade in November 2023, signifying the emergence of untreated infections. Pituitary involvement in syphilis is a very rare phenomenon, and endocrinological investigation is often overlooked. This will be the second reported case of neurosyphilis with pituitary involvement in a non-HIV infected patient. A 45-year-old female with no significant past medical history was admitted to the hospital with progressive neurological symptoms of intermittent left-side headache, hearing loss with tinnitus, and gait instability. Postcontrast MRI Brain revealed multifocal leptomeningeal enhancement involving supratentorial and infratentorial regions. Thickening of the enhanced pituitary infundibulum was also noted. Subsequent RPR titer showed 1:16 and lumbar puncture revealed CSF-VDRL titer 1:32, with pleocytosis 83 cells/uL, CSF-glucose 19 mg/dL, and CSF-protein 370 mg/dL. The patient completed Penicillin G 4 million/units intravenous every 4 hours for 14 days, with repeat MRI showing significant interval decrease in previously described extensive supratentorial and infratentorial leptomeningeal enhancement. However, there is no record of her sexual partner receiving treatment. The patient was readmitted one year later after a fall while displaying dysmetria. MRI Brain with contrast revealed a small subacute infarct along the right frontal corona radiata and pituitary gland measuring up to 1.2 cm in craniocaudal dimension compared to 0.4 cm on the prior exam. This prompted evaluation of pituitary hormones: FSH 0.8 IU/L, LH <0.3 IU/L, and ACTH 6.3 pg/mL, with normal serum growth hormone and prolactin levels. Further investigation revealed morning cortisol 2.5 ug/dL, thyrotropin < 0.2 uIU/mL, and free thyroxine 0.63 ng/dL. Radiological evidence is suspicious of inflammatory etiology of the pituitary gland. The patient was discharged with endocrinology follow-up and plan to perform a pituitary gland biopsy as an outpatient for confirmatory result. The association of neurosyphilis and hypophysitis leading to panhypopituitarism in a non-HIV infected patient was first reported in 2015. Since then, there remains limited research regarding their association due to rarity of pituitary involvement in neurosyphilis. With untreated syphilis on the rise and increased availability of MRI, clinicians should expect to encounter more cases of neurosyphilis with pituitary involvement in the future. Early detection of panhypopituitarism in those with positive CSF-VDRL titer could lead to better clinical outcomes. It is paramount that these cases are documented to emphasize pituitary involvement in neurosyphilis and encourage a low threshold to initiate endocrinological testing in the future. Presentation: 6/3/2024

Syphilis Should not be Overlooked in any Individual, Irrespective of their Condition.

Syphilis remains a significant challenge in public health, largely because of its diverse clinical manifestations, often resulting in underdiagnosis especially among patients with neurogenic disability. We present a case of neurosyphilis in a 63-year-old patient with a spinal cord injury. Despite syphilis being a well-established sexually transmitted infection, the exacerbation of neurological and dermatological symptoms during physical examination prompted an investigation into alternative causes beyond the patient's pre-existing paraparesis, ultimately resulting in the diagnosis of neurosyphilis. This case highlights the importance of considering syphilis as a potential diagnosis in individuals regardless of their medical history. The incidence of syphilis cases is on the rise, presenting an ongoing challenge.Faced with atypical neurological symptomatology, it is necessary to know how to investigate and discuss tertiary syphilis.In the event of neurological worsening in a neuro-injured patient, it is necessary to know how to discuss a curable diagnosis.

TABES DORSALIS: IS THE DIAGNOSIS A CHALLENGE NOWADAYS?

Purpose: To present a rare case of neurosyphilis, the tertiary form of syphilitic infection, following adequate but belated treatment and manifesting with a variety of clinical signs and further progression to tabetic neurosyphilis. Known as the "great imitator", neurosyphilis is often misdiagnosed and underestimated. Materials/methods: A 48-year-old male patient was admitted to the Neurology clinic of UMHAT "Dr Georgi Stranski" Pleven, Bulgaria, with progressive neurological deficit including numbness in the lower limbs, imbalance and wide-based gait. The T2W- MRI showed abnormally high longitudinal signals at Th12-L1 level, consistent with transverse myelitis. CSF analysis revealed leucocytic pleocytosis, elevated proteins and normal glucose. The nerve conduction studies confirmed sensory motor polyneuropathy. Results: After treatment with intravenous aqueous crystalline (IV) penicillin, 2 million intravenously every 4 hours for 20 days, the sensory symptoms reduced. The coordination disturbances persisted, but the gate showed moderate improvement. Conclusions: The diagnosis of syphilitic myelitis, known as tabes dorsalis, is always complex, not only because of its rarity but because of its unique clinical presentation with multiple clinical symptoms, mimicking other more common neurological disorders. Though confirmation of the diagnosis needs a lot of laboratory and neuroimaging studies, the option of effective specific treatment is worth all the efforts.

NEUROSYPHILIS IN PEDIATRIC POPULATION: A REVIEW OF CASES

Background: Neurosyphilis is the most severe presentation of acquired and congenital syphilis, it occurs when Treponema pallidum penetrates the central nervous system. This development can occur at any time during the evolution of the disease phases. In Brazil in 2021, 2,343 children born with congenital syphilis were diagnosed with neurosyphilis, representing 9.3% of the total. The objective of this study was to analyze the scientific evidence on the medical manifestations presented by pediatric patients affected by neurosyphilis. Methods: In February 2023, PubMed, VHL, Scopus, Lilacs and Bdenf databases were researched for published case reports of patients aged zero to less than 18 years with T. pallidum infection. The data analysis period covered 55 years. Results: Nine articles were found in the period of publication from 1967 to 2022. There were two cases in females and only one with manifestation in an adolescent of acquired neurosyphilis. The adolescent's case was the only one with a favorable outcome after adequate treatment. Other cases resulted in impaired quality of life for patients and family members involved in child care. Conclusion: The reported cases of neurosyphilis were mostly related to late diagnosis. Evidencing the fragility of prenatal care, which is crucial for prevention and intervention by T. pallidum infection causes serious consequences for child development. Therefore, control measures should focus on mandatory prenatal screening during the first trimester of pregnancy, partner notification, prompt treatment and postnatal follow-up of the newborn.

Secondary recurrent syphilis in a patient with HIV infection. Clinical case

Relevance. HIV infection is a chronic sexually transmitted infectious disease. Given the single route of transmission, quite often HIV-infected patients develop a syphilitic infection. At the same time, syphilis against the background of HIV infection has its own clinical characteristics. It is important for doctors of various specialties to know these features.Description of the case. A clinical case of secondary syphilis and early neurosyphilis in a 52-year-old patient with HIV infection is presented.Discussion. Patients with HIV infection are characterized by unusual clinical manifestations of syphilis in the form of its malignity, atypical, severe course with the development of various complications. In the article, the authors describe atypical manifestations of papular syphilide of the palms and soles. The effectiveness of specific treatment has been shown.Conclusions. Doctors’ knowledge of the clinical features of syphilis against the background of HIV infection will allow them to avoid diagnostic errors leading to late treatment and the development of complications.

A Case of Neurosyphilis with Isolated Optic Neuritis

A Case of Neurosyphilis with Isolated Optic Neuritis

Neurosyphilis is characterized by a compartmentalized and robust neuroimmune response but not by neuronal injury

Neurosyphilis is increasing in prevalence but its pathophysiology remains incompletely understood. This study assessed for CNS-specific immune responses during neurosyphilis compared to syphilis without neurosyphilis and compared these immune profiles to those observed in other neuroinflammatory diseases. Participants with syphilis were categorized as having neurosyphilis if their cerebrospinal fluid (CSF)-venereal disease research laboratory (VDRL) test was reactive and as having syphilis without neurosyphilis if they had a non-reactive CSF-VDRL test and a white blood cell count <5/μL. Neurosyphilis and syphilis without neurosyphilis participants were matched by rapid plasma reagin titer and HIV status. CSF and plasma were assayed for markers of neuronal injury and glial and immune cell activation. Bulk RNA sequencing was performed on CSF cells, with results stratified by the presence of neurological symptoms. CSF neopterin and five CSF chemokines had levels significantly higher in individuals with neurosyphilis compared to those with syphilis without neurosyphilis, but no markers of neuronal injury or astrocyte activation were significantly elevated. The CSF transcriptome in neurosyphilis was characterized by genes involved in microglial activation and lipid metabolism and did not differ in asymptomatic versus symptomatic neurosyphilis cases. The CNS immune response observed in neurosyphilis was comparable to other neuroinflammatory diseases and was present in individuals with neurosyphilis regardless of neurological symptoms, yet there was minimal evidence for neuronal or astrocyte injury. These findings support the need for larger studies of the CSF inflammatory response in asymptomatic neurosyphilis. This work was funded by the National Institutes of Health, grants K23MH118999 (S.F.F.) and R01NS082120 (C.M.M.).

First episode psychosis: what can we learn from a case of neurosyphilis?

First episode psychosis: what can we learn from a case of neurosyphilis?

Enhancing clinical awareness: retrospective analysis of neurosyphilis cases and diagnostic predictors for early recognition and treatment.

This is a retrospective analysis of clinical data from individuals diagnosed with neurosyphilis, aiming to enhance healthcare professionals' understanding of the disease and expedite early diagnosis and intervention. A retrospective analysis was conducted on the clinical records of 50 patients who received a diagnosis of symptomatic neurosyphilis and were admitted to the Neurology Department during the period spanning January 2012 to December 2022. Clinical manifestations encompassed diverse phenotypes, with syphilitic meningitis accounting for 16% of cases, characterized by symptoms such as headache, blepharoptosis, paralysis, blurred vision, and tinnitus. Meningovascular syphilis presented in 36% of cases, exhibiting episodic loss of consciousness, limb numbness, and limb convulsion. Paralytic dementia manifested in 36% of cases, featuring symptoms such as memory loss, sluggish response, and slow movement. Tabes dorsalis was observed in 12% of cases, presenting with weakness, numbness, and staggering. Routine cerebrospinal fluid (CSF) analysis indicated abnormal white blood cell counts in 60% of patients, while biochemical testing revealed abnormal protein content in 52% of patients. Notably, statistically significant differences were observed between patients with interstitial and parenchymatous neurosyphilis (Z = 2.023, P = 0.044) in terms of CSF protein content. Electroencephalogram (EEG) results were abnormal in six patients, and imaging studies unveiled diverse findings in 46 patients. The study highlights the importance of neurological and/or ocular symptoms in diagnosing symptomatic neurosyphilis. Individuals with hypomnesia should be closely monitored for potential neurosyphilis. Integrating clinical manifestations, laboratory tests, EEG, and imaging can reduce misdiagnosis. This comprehensive approach shows promise in improving early identification and management of neurosyphilis.

A Case of Neurosyphilis Presenting with Isolated Abducens Nerve Palsy.

We herein report a case of neurosyphilis that presented with isolated bilateral abducens nerve palsy. A 39-year-old man was referred to our department with diplopia. He had a history of homosexual relationships and showed only bilateral abducens nerve palsy upon a neurological examination. Positive syphilis tests in the serum and cerebrospinal fluid and a contrasting effect on the abducens nerve on magnetic resonance imaging (MRI) confirmed the diagnosis of active neurosyphilis. When a patient manifests isolated abducens nerve palsy, neurosyphilis can be a differential diagnosis, although rare, and contrast-enhanced MRI may help diagnose the disease.

Cerebrospinal fluid CXCL13 concentration for diagnosis and monitoring of neurosyphilis in people with HIV.

The study aimed to assess and compare cerebrospinal fluid (CSF)-CXCL13 levels in People with HIV (PWH) with suspected neurosyphilis (NS), those with syphilis but without NS, and patients without treponema infection. Additionally, it aimed to evaluate changes in CSF-CXCL13 concentrations before and after antibiotic treatment. This was a prospective cohort study involving 93 PWH suspected of NS. All participants underwent lumbar puncture, with CSF-CXCL13 levels measured at baseline and during follow-up in patients diagnosed with NS. CSF-CXCL13 levels were quantified using ELISA. The Mann-Whitney U test was used to analyze differences between groups, while the Wilcoxon test assessed within subject changes. ROC curve analysis determined the diagnostic efficacy of CSF-CXCL13 for NS. Significantly higher CSF-CXCL13 levels were observed in patients with NS compared to those with syphilis without NS and non-syphilis patients. Posttreatment, a decline in CSF-CXCL13 levels was noted in all NS cases. A CSF-CXCL13 threshold exceeding 60.0 pg/ml, in conjunction with reactive CSF-FTA-ABS, yielded a sensitivity of 88.9% and a specificity of 97.6% for NS diagnosis. CSF-CXCL13 emerges as a valuable adjunctive biomarker for detecting NS in PWH, especially in cases with nonreactive CSF-VDRL. Monitoring CSF-CXCL13 levels also appears effective in evaluating therapeutic response in PWH undergoing NS treatment.

Syphilis and some other STIs in the Russian Federation: past, present and ways to control of the epidemiological situation in the future

The article is devoted to assessing the situation with syphilis and other sexually transmitted infections in the USSR and Russia in the period after the Second World War. On the basis of long-term statistical data, the patterns of rises and decreases in syphilis, gonorrhea, chlamydia infection are analyzed, possible factors influencing the epidemic process are discussed and a comparative assessment of the current situation in Russia and Western countries is carried out. Comparing to the previous year, there was an increase of the syphilis incidence by 39.4% in 2021, by 33.7% in 2022 and by 14.7% in the first 4 months of 2023. The incidence of gonococcal infection increased by 10.4%, 10.0% and 5.5%, respectively. The attention is drawn to the negative trend of an increase of latent and late syphilis among other forms, as well as rising number of late neurosyphilis and late cardiovascular syphilis cases. In view of the predicted increase in the incidence of syphilis and other STIs in the coming years, the authors emphasize the urgent need to develop and implement a state interdisciplinary program aimed to epidemiological monitoring, improvement of the diagnosis and treatment, prevention of the dissemination of syphilis and other STIs and controlling of factors that negatively affect the reproductive health of the nation.

Neurosyphilis Presenting as Limbic Encephalitis: a Case Report (P10-10.007)

<h3>Objective:</h3> To present an interesting case of neurosyphilis mimicking limbic encephalitis. <h3>Background:</h3> Neurosyphilis can occur at any stage of infection and it classically presents as meningitis, cranial neuropathies, vasculitis, tabes dorsalis, or neuropsychiatric manifestations, however rarely temporal lobe abnormalities resembling limbic encephalitis have been reported. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 51-year-old male with no past medical history presents initially with 3 weeks of altered mental status, confusion and memory loss. Prior to admission to the hospital, he presented with a generalized tonic-clonic seizure. His MRI showed T2 hyperintensities in the left hippocampus, amygdala, and mesial temporal lobe with associated diffusion restriction. Cerebrospinal fluid (CSF) studies showed 58 white blood cells/mm3 (73% lymphocytes), a protein concentration of 165 mg/dL and a glucose concentration of 35 mg/dL. HIV serology, serum cryptococcal Antigen, HSV and VZV PCR on CSF and neuronal autoantibodies on serum were negative. EEG showed left lateralized periodic discharges. The patient was initially treated with empiric anti-infective therapy including acyclovir, ceftriaxone, and ampicillin. Subsequently, serum syphilis screen was positive with reflex Rapid Plasma Reagin (RPR) titer at 1:64. CSF Venereal Disease Research Laboratory (VDRL) was positive at 1:64. In light of these results, the patient was transitioned to intravenous aqueous penicillin G 24 million units daily through continuous infusion. His mental status markedly improved after a few days of treatment. Repeat EEG showed only mild encephalopathy. He was discharged on levetiracetam and high dose IV penicillin G to complete a 14-day course. <h3>Conclusions:</h3> Syphilis is commonly known as a great imitator; it is a treatable condition so it should not be missed. We need to be more cognizant of this diagnosis when evaluating patients with temporal lobe involvement on MRI, lymphocytic pleocytosis and hypoglycorrhachia. Although HSV and autoimmune diseases are the most common causes of limbic encephalitis, as presented in our case, syphilis testing should be considered. <b>Disclosure:</b> Dr. Hu has nothing to disclose. Dr. El Helou has nothing to disclose. Nayrobi Pena Cotui has nothing to disclose. Dr. Balobaid has nothing to disclose. Dr. Montalvo Perero has nothing to disclose.

Neuroszifilisz esetek a Semmelweis Egyetem ÁOK Bőr-, Nemikórtani és Bőronkológiai Klinikán 2011–2022. között

Neurosyphilis occurs as part of syphilis in the central nervous system and can manifest at any stage of the infection. In recent years, with the increase in the syphilis infection rate, the incidence of neurosyphilis has gradually increased. Nowadays, typical symptoms of neurosyphilis have become rare, and atypical manifestations have increased. Diagnosis and treatment of neurosyhilis is a multidiciplinary task, which may challenge practicing venerologists. In our retrospective research, we analyzed the epidemiological, clinical, laboratory and therapeutic data of 175 patients diagnosed with neurosyphilis in a 10- year period between 2011 and 2022, at the Department of Dermatology, Venereology and Dermatooncology.

A Case of Early Neurosyphilis Diagnosed with Vision and Hearing Disturbance

A Case of Early Neurosyphilis Diagnosed with Vision and Hearing Disturbance

Recent Advances in Laboratory Diagnosis of Syphilis

Syphilis is a sexually transmitted disease caused by Treponema pallidum subsp. pallidum. This historical disease has diverse clinical manifestations making laboratory testing crucial for optimal patient management. Direct detection of T.pallidum by dark-field microscopy is possible when lesions are present. Culture of the bacteria is complex and not performed routinely. There is no well-validated commercially available polymerase chain reaction (PCR) test. Serological tests are currently the most common diagnostic methods adapted in clinical laboratories. They provide a presumptive diagnosis and used for screening, diagnosis, and follow-up of the treatment. They are divided into two groups, named as nontreponemal and treponemal tests and performed by the application of the traditional algorithm, the reverse sequence algorithm or European Centre for Disease Prevention and Control (ECDC) algorithm. The traditional algorithm starts with a nontreponemal test and a reactive result is confirmed with a treponemal test. In the reverse sequence algorithm, a treponemal test is used for screening and a reactive result is confirmed by a quantitative nontreponemal test. When the nontreponemal test is negative, a second different treponemal test preferably T.pallidum particle agglutination test (TPPA) is used. The ECDC algorithm recommends screening by a treponemal test such as T.pallidum enzym immunoassay (TP-EIA), T.pallidum chemiluminescence immunoassay (CIA) and if reactive, a reflex confirmatory treponemal test is performed. The treponemal tests become reactive a few weeks after infection and remain reactive even after successful treatment. The nontreponemal tests are used to assess disease activity and response to therapy. Serological tests have many limitations such as false-positivity, falsenegativity in various stages of the disease and also challenging difficulties when evaluating response to therapy. In recent years, rapid syphilis tests which are mostly treponemal-specific tests have been developed for high-prevalence populations in resource limited settings. There has been requirement for the utility of standart PCR and IgM testing in the diagnosis of congenital syphilis and neurosyphilis cases. In this review article, it was aimed to present the diagnostic tests, the algorithms, the correct indications for testing and interpretation of the test results to the likely corresponding clinical stage of the disease with in the perspective of recent advances.

CARE-NS, a research strategy for neurosyphilis.

Neurosyphilis is a major clinical manifestation of syphilis. In recent years, an increase in neurosyphilis cases has been reported in many countries. The overall incidence of neurosyphilis remains unknown, and there is a lack of understanding of the disease pathogenesis, which hampers clinical management, development of prevention strategies, and control. This article proposes the CARE-NS research strategy to enhance the clinical management of neurosyphilis, which consists of six key features: comprehensive management including multidisciplinary treatment (C), alleviating neurological impairment and sequelae (A), risk factors and clinical epidemiology (R), etiology and pathogenesis (E), new diagnostic indicators and strategies (N), and social impact and cost-effectiveness analysis (S).

Every Rash is Important – A Rare Case of Neurosyphilis in Renal Transplant Patient

In immunocompromised conditions, latent syphilitic infection can lead to secondary syphilis. We present here a case of neurosyphilis (syphilitic meningomyelitis) in a kidney transplant recipient. Atypical presentation, the typical maculopapular rash, and a serological test all pointed to secondary syphilis. The scenario illustrates a crucial point: infections can go undetected, whereas a patient is on immunosuppressive therapy.