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Yazigi A, Yazigi M, Zainah H. A Rare Case of Neurosyphilis Manifesting as Psychosis in an HIV-Negative Patient. Cureus 2023; 15:e40064. [PMID: 37425525 PMCID: PMC10325951 DOI: 10.7759/cureus.40064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Neurosyphilis is a rare disease now, given the availability of antibiotics to treat syphilis. Patients with neurosyphilis could present with psychiatric symptoms. We present a rare case of neurosyphilis with only psychiatric symptoms. The patient was a 49-year-old male who presented with self-neglect and was not interacting with others. Treponema antibodies were positive, and rapid plasma reagin (RPR) was 1:512 with a positive venereal disease research laboratory test (VDRL) in the cerebrospinal fluid. The patient was treated with an IV penicillin regimen for neurosyphilis and improved remarkably with a return to baseline on follow-up.
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Affiliation(s)
- Angela Yazigi
- Infectious Diseases, Al-Baath University, Faculty of Medicine, Homs, SYR
| | - Majed Yazigi
- Infectious Diseases, Al-Baath University, Faculty of Medicine, Homs, SYR
| | - Hadeel Zainah
- Infectious Diseases, Kent-County Memorial Hospital, Warwick, USA
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Akashi Hasegawa K, Takahashi Y, Morimoto M, Yokota K, Morimoto N. [A case of neurosyphilis presenting as sudden onset of limbic encephalitis]. Rinsho Shinkeigaku 2023; 63:15-20. [PMID: 36567101 DOI: 10.5692/clinicalneurol.cn-001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 52-year-old male was carried to hospital by ambulance, because of an abrupt abnormal behavior and impaired consciousness. Soon after the arrival, the patient started a generalized seizure. Although the seizure was stopped by Midazolam, amnesia were observed. With meningeal irritation signs, in addition to the clinical course, the patient was thought to develop limbic encephalitis. The cause of the encephalitis was diagnosed as neurosyphilis because of the positive serum and CSF syphilis reactions, and the patient was treated with penicillin G from the first admission day on. Steroid pulse therapy was also conducted, followed by acyclovir since herpes encephalitis could not be ruled out; the brain MRI showed left-side dominant T2/FLAIR high intensity lesions in the bilateral temporal lobes and left hippocampus. With the treatment progression, the amnestic syndrome improved and the patient returned to work. Although neurosyphilis is a rare cause of acute onset limbic encephalitis, it is important to keep the possibility of this disease in mind in making a treatment plan.
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Affiliation(s)
| | | | | | - Kyoko Yokota
- Infectious Diseases, Kagawa Prefectural Central Hospital
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Status Epilepticus and Neurosyphilis: A Case Report and a Narrative Review. NEUROSCI 2021. [DOI: 10.3390/neurosci2040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neurosyphilis is a rare but life-threatening complication of syphilis that can develop even decades after the primary infection and can be unrecognized. Seizures and status epilepticus (SE) may represent the first manifestation in a previously undiagnosed syphilitic patient. We present an exemplification case of a new onset refractory status epilepticus caused by neurosyphilis and we reviewed the existing literature. We selected all studies reporting cases of SE in the context both of patients with a known diagnosis of syphilis and as the first manifestation of neurosyphilis. We identified 50 patients, mostly composed of immunocompetent, middle-aged males. Thirty-nine patients (83%) presented a new onset SE. A history of subtle and rapidly progressive mood and/or cognitive impairment suggesting a limbic encephalitis-like presentation was frequently observed. Focal frontal or temporal SE was reported in 26. Brain MRI frequently showed T2/FLAIR hyperintensities widely involving the medial temporal structures and the frontal lobes. This review should increase the clinician’s awareness of neurosyphilis as a possible etiology of a new onset SE of unknown etiology, especially in the context of a “limbic encephalitis”-like clinical presentation. Prompt recognition and treatment for neurosyphilis partially or completely reverse neurologic sequelae, changing the natural history of the disease.
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A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder. J Psychiatr Pract 2019; 25:222-226. [PMID: 31083037 DOI: 10.1097/pra.0000000000000390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Limbic encephalitis is an inflammatory process of the limbic structures, with polymorphic clinical features, caused by paraneoplastic and nonparaneoplastic conditions and infections. We describe a case of neurosyphilis limbic encephalitis, presenting with reversible Geschwind syndrome (hyperreligiosity and hypergraphia) and mood disorder due to the predominant involvement of left mesial temporal structures in a previously healthy 34-year-old, left-handed woman. Because neurosyphilis can mimic common neuropsychiatric syndromes, it should be included in the differential diagnosis of psychiatric disorders with suspected general medical causes. This case of nondominant limbic encephalopathy caused by syphilis infection highlights the relevance of a careful investigation for secondary psychotic, mood, and personality disorders when assessing new-onset psychiatric illness and the importance of a multidisciplinary approach to provide a better outcome in patients with neurosyphilis.
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Abstract
We report a case of neurosyphilis with magnetic resonance imaging (MRI) brain scan findings compatible with a diagnosis of herpes simplex encephalitis with negative testing for herpes simplex virus in the cerebral spinal fluid. An extensive review of the literature has been undertaken revealing 24 cases worldwide where there are mesiotemporal changes on MRI concurrent with a diagnosis of neurosyphilis. Therefore, it is now well established that neurosyphilis, 'the great imitator', should be considered in the differential diagnosis in all patients demonstrating mesiotemporal changes on MRI, changes usually seen in herpes simplex encephalitis.
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Affiliation(s)
- R B Saunderson
- Department of Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Abstract
Neurosyphilis may presents with a range of psychiatric symptoms. This report illustrates a case of neurosyphilis in a man who presented with psychosis and cognitive dysfunction. Clinical findings and investigations done in the present case showed positive results for syphilis. Reduction of symptoms was noted after treatment with antibiotic. This case further highlights the importance of having high index of suspicion for neurosyphilis in patients presenting with psychiatric symptoms.
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Affiliation(s)
- Suzaily Wahab
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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Gaud S, Sauvée M, Muresan M, Gospodaru N, Foscolo S, Debouverie M. Lésions mésiotemporales gauches et amnésie antérograde : un cas de neurosyphilis. Rev Neurol (Paris) 2011; 167:833-6. [DOI: 10.1016/j.neurol.2011.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 02/28/2011] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
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Kuppasani K, Vadehra VK, Reddi AS. New-onset status epilepticus develops after a motor vehicle collision. JAAPA 2010; 23:31-2, 34, 39. [PMID: 20845652 DOI: 10.1097/01720610-201009000-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kishore Kuppasani
- The University Hospital, University of Medicine and Dentistry of New Jersey, Newark, USA
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Sesar A, Arias M, Requena I, Pereiro I. Status epilepticus secondary to luetic encephalitis: evolution of neuroimaging findings. J Neurol 2008; 255:438-40. [DOI: 10.1007/s00415-008-0574-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 12/17/2006] [Accepted: 12/23/2006] [Indexed: 10/22/2022]
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Hama K, Ishiguchi H, Tuji T, Miwa H, Kondo T. Neurosyphilis with mesiotemporal magnetic resonance imaging abnormalities. Intern Med 2008; 47:1813-7. [PMID: 18854635 DOI: 10.2169/internalmedicine.47.0983] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a patient with mesial temporal T2-weighted image hyperintensity on magnetic resonance imaging that mimicked paraneoplastic limbic encephalitis. The patient showed pupillary abnormalities suggestive of a diagnosis of neurosyphilis, and the diagnosis was supported by the results of a serum Treponema pallidum hemagglutination assay (TPHA) and cerebrospinal fluid examination. Making a diagnosis of neurosyphilis is occasionally difficult because of the variety of clinical and imaging findings. Appropriate diagnosis and commencing adequate treatment are needed for a good prognosis; thus, neurosyphilis should be included in the differential diagnosis of mesiotemporal magnetic resonance imaging abnormalities.
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Affiliation(s)
- Kiwa Hama
- Department of Neurology, Wakayama Medical University, Wakayama.
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Gürses C, Bilgiç B, Topçular B, Tuncer OG, Akman-Demir G, Hanağasi H, Baslo B, Gürvit H, Coban O, Emre M, Idrisoğlu HA. Clinical and magnetic resonance imaging findings of HIV-negative patients with neurosyphilis. J Neurol 2007; 254:368-74. [PMID: 17345038 DOI: 10.1007/s00415-006-0380-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Accepted: 04/07/2006] [Indexed: 11/25/2022]
Abstract
There have been no serial studies about neuroradiological findings of neurosyphilis in the literature. There have been only case reports concerning HIV negative patients with neurosyphilis. We present 8 HIV negative neurosyphilis patients two of whom are women. The mean age of the patients was 48 years+/-12.37. Five of the 8 patients had general paresis, two optic atrophy and one multiple cranial neuropathies. The CSF findings were quite similar in 6 of 8 patients. In half of the patients cranial MRI showed mild cerebral atrophy. Nonspecific hyperintense small foci in 3 patients are thought to be related to syphilis. Hyperintensity involving bilateral medial and anterior temporal regions more prominent on the left side was seen in one of the patients with general paresis. This finding may be due to cytotoxic edema associated with status epilepticus and may mimic herpes simplex and other limbic encephalitides. Though not typical, certain MRI findings guides for the diagnosis of neurosyphilis.
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Affiliation(s)
- Candan Gürses
- Department of Neurology, Faculty of Medicine, University of Istanbul, 34390, Capa, Istanbul, Turkey.
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Reply to Dr. Scheid’s Letter to the Editor regarding “Differential diagnosis of mesiotemporal lesions: case report of neurosyphilis”. Neuroradiology 2006. [DOI: 10.1007/s00234-006-0088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Scheid R, Voltz R, Vetter T, Sabri O, von Cramon DY. Neurosyphilis and paraneoplastic limbic encephalitis: important differential diagnoses. J Neurol 2005; 252:1129-32. [PMID: 15789128 DOI: 10.1007/s00415-005-0812-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Revised: 01/04/2005] [Accepted: 01/27/2005] [Indexed: 10/25/2022]
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Abstract
Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in the course of disease but causes persistent infection in only a subset of infected persons. Individuals with persistent infection or asymptomatic meningitis are at risk for developing symptomatic neurosyphilis if they are not treated with a drug regimen that achieves sufficient drug levels in cerebrospinal fluid to kill the organism. In this article, recent studies that address the risk, diagnosis, and management of neurosyphilis are discussed within the context of a brief review. Particular attention is given to current controversies. In the developed world, these issues are particularly relevant to persons who are infected with HIV.
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Affiliation(s)
- Christina M Marra
- University of Washington School of Medicine, Harborview Medical Center, Neurology, Box 359775, 325 9th Avenue, Seattle, WA 98104-2499, USA.
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