Case Rep Ophthalmol Med. 2012;2012:621872. Epub 2012 Feb 26.

Neurosyphilis presenting as asymptomatic optic perineuritis.

Parker SE, Pula JH.

Source

Neuro-ophthalmology Unit, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, Peoria, IL 61611, USA.

Abstract

Introduction. Syphilis is a sexually transmitted disease that is known as "the great imitator" due to its wide variety of clinical presentations, including ocular disorders. There has been an increase in the rate of syphilis in the United States, especially in persons with HIV. We report a case of optic perineuritis in an asymptomatic male secondary to central nervous system (CNS) syphilis. Case Report. A 41-year-old man was found to have bilateral disc edema on a routine exam. Brain MRI was unremarkable, and lumbar puncture revealed a normal opening pressure, with an elevated cerebrospinal fluid white cell count. Orbit MRI showed optic nerve sheath expansion and enhancement, consistent with optic perineuritis. He tested positive for syphilis based on serum RPR and FTA-ABS. Conclusion. Ophthalmologic findings, including disc edema, may be the presenting features of CNS syphilis. Even in asymptomatic persons, perineuritis should be considered early, as diagnosis and treatment are imperative given the progressive nature of the disease.

BMJ Case Rep. 2012 Mar 20;2012. pii: bcr0920114784. doi: 10.1136/bcr.09.2011.4784.

An unusual cause for hyponatremia with seizures.

Naha K, Vivek G, Dasari S, Manthappa M, Dias L, Acharya R.

Source

Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India.

Abstract

A 50-year-old Asian Indian female with known hypertension presented with persistent vomiting but no other symptoms of meningism. Clinical examination and basic laboratory parameters were entirely normal except for significant hyponatremia. Further investigation was suggestive of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Subsequently, despite steady correction of hyponatremia, the patient developed generalised seizures. Cerebrospinal fluid (CSF) analysis performed was inconclusive. Screening for a chronic meningitis underlying SIADH, yielded positive blood and CSF titres for venereal disease research laboratory (VDRL), which were confirmed by Treponema pallidum haemagglutination (TPHA). The patient was treated for neurosyphilis and made a complete recovery. Hyponatremia resolved and she had no further episodes of seizures. She was tested for HIV infection which was negative. On follow-up, she remained TPHA positive but VDRL titres became negative.

J Midwifery Womens Health. 2012 May;57(3):276-84. doi: 10.1111/j.1542-2011.2012.00179.x.

What's New in Sexually Transmitted Infection Management: Changes in the 2010 Guidelines from the Centers for Disease Control and Prevention.

Mark H, Jordan ET, Cruz J, Warren N.

Abstract

Screening, treatment, and follow-up of sexually transmitted infections (STIs) are an important part of the role of women's health care providers. Keeping abreast of new and changing treatment guidelines is crucial to providing competent care. The Sexually Transmitted Diseases Treatment Guidelines, produced every 4 years by the Centers for Disease Control and Prevention, summarize current evidence on prevention, diagnosis, and treatment of STIs. The purpose of this article is to review the changes in the 2010 guidelines from the previous 2006 guidelines. These changes include new diagnostic tests for bacterial vaginosis, Neisseria gonorrhoeae, and human papillomavirus; new treatment recommendations for bacterial vaginosis, gonorrhea, and genital warts; the increasing prevalence of antimicrobial-resistant N gonorrhoeae; new criteria for spinal fluid examination to evaluate for neurosyphilis; and the emergence of azithromycin-resistant Treponema pallidum.

Sex Transm Dis. 2012 Jun;39(6):453-7.

The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis.

Marra CM, Tantalo LC, Maxwell CL, Ho EL, Sahi SK, Jones T.

Source

From the *Departments of Neurology and †Medicine (Infectious Diseases), University of Washington, Seattle, WA.

Abstract

BACKGROUND:

: The cerebrospinal fluid (CSF) Venereal Disease Research Laboratory (VDRL) test is a mainstay for neurosyphilis diagnosis, but it lacks diagnostic sensitivity and is logistically complicated. The rapid plasma reagin (RPR) test is easier to perform, but its appropriateness for use on CSF is controversial.

METHODS:

: RPR reactivity was determined for CSF from 149 individuals with syphilis using 2 methods. The CSF-RPR was performed according to the method for serum. The CSF-RPR-V was performed using the method recommended for the CSF-VDRL. Laboratory-defined neurosyphilis included reactive CSF-fluorescent treponemal antibody absorption test and CSF white blood cells >20/uL. Symptomatic neurosyphilis was defined as vision loss or hearing loss.

Results:

: CSF-VDRL was reactive in 45 (30.2%) patients. Of these, 29 (64.4%) were CSF-RPR reactive and 37 (82.2%) were CSF-RPR-V reactive. There were no instances where the CSF-VDRL was nonreactive but the CSF-RPR or CSF-RPR-V was reactive. Among the 28 samples that were reactive in all 3 tests, CSF-VDRL titers (median [IQR], 1:4 [1:4-1:16]) were significantly higher than CSF-RPR (1:2 [1:1-1:4], P = 0.0002) and CSF-RPR-V titers (1:4 [1:2-1:8], P = 0.01). The CSF RPR and the CSF-RPR-V tests had lower sensitivities than the CSF-VDRL: 56.4% and 59.0% versus 71.8% for laboratory-diagnosed neurosyphilis and 51.5% and 57.6% versus 66.7% for symptomatic neurosyphilis.

Conclusions:

: Compared with the CSF-VDRL, the CSF-RPR has a high false-negative rate, thus not improving upon this known limitation of the CSF-VDRL for neurosyphilis diagnosis. Adapting the RPR procedure to mimic the CSF-VDRL decreased, but did not eliminate, the number of false negatives and did not avoid all the logistical complications of the CSF-VDRL.

Ugeskr Laeger. 2012 May 14;174(20):1366-1367.

[Neurosyphilis is topical again as a differential diagnosis.]

[Article in Danish]

Linnebjerg LB, Wetke R.

Source

Audiologisk Klinik, Aarhus Universitetshospital, Peter Sabroes Gade 6, Bygning 14F, 8000 Aarhus C. linda@linnebjerg.com.

Abstract

Within years the incidence of syphilis has increased in Denmark. The current case describes a homosexual man with a sudden onset of bilateral sensorinerual hearing loss and tinnitus along with a universal skin rash, muscular pain, and headache. He recieved intravenous penicillin 7 MIE × 3 for 15 days. The hearing loss and tinnitus persisted, and he was fitted with bilateral hearing aids. The hearing loss might have been reversible had he been treated sooner. This case stresses the importance of considering neurosyphilis in cases of odd symptoms and hearing loss of unknown origin.

Case Rep Infect Dis. 2012;2012:154863. Epub 2012 Feb 16.

Neurosyphilis versus Herpes Encephalitis in a Patient with Confusion, Memory Loss, and T2-Weighted Mesiotemporal Hyperintensity.

Vedes E, Geraldo AF, Rodrigues R, Reimão S, Ribeiro A, Antunes F.

Source

Internal Medicine Department, Centro Hospitalar Lisboa Norte, EPE, 1649-035 Lisbon, Portugal.

Abstract

Acute confusion and memory loss associated with asymmetrical mesiotemporal hyperintensity on T2-weighted MRI are characteristic of herpes encephalitis. The authors report the case of a patient with these symptoms and MRI presentation who had neurosyphilis. Recently clinical and imaging patterns usually associated with herpes simplex encephalitis have been seen in patients with neurosyphilis. Because syphilis is "The Great Pretender" not only clinically but also in imaging and because its numbers are rising, it must be sought as a differential diagnosis.

Bipolar Disord. 2012 May;14(3):309-12. doi: 10.1111/j.1399-5618.2012.01007.x.

Neurosyphilis presenting as mania.

Barbosa IG, Vale TC, de Macedo DL, Gomez RS, Teixeira AL.

Source

Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Section and Laboratory of Stress, Psychiatry, and Immunology (SPI-Lab), Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK Serviço de Neurologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Abstract

Barbosa IG, Vale TC, de Macedo DL, Gomez RS, Teixeira AL. Neurosyphilis presenting as mania. Bipolar Disord 2012: 14: 309-312. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective:  General paresis of the insane is a late and severe form of neurosyphilis characterized by nonspecific neuropsychiatric symptoms. There are a limited number of case reports of mood disorders presenting in neurosyphilis, with depressive illness being the most common. Methods:  We performed a literature review of case reports of secondary bipolar disorder induced by syphilitic infection. Results:  Herein reported is a case of a 53-year-old woman who initially presented with symptoms of mania and depression, mimicking bipolar disorder, but was subsequently diagnosed with general paresis of the insane. Conclusion:  The present case report emphasizes that if a substantial delay occurs in syphilis diagnosis and management, the patient may have a very poor prognosis.

J Neurol Sci. 2012 Jun 15;317(1-2):35-9. Epub 2012 Apr 4.

Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients.

Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG, Lin LR, Yang TC.

Source

Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen 361004, China; Xiamen Zhongshan Hospital, Fujian Medical University, Xiamen 361004, China.

Abstract

BACKGROUND:

Neurosyphilis is known as "the great imitator" or "the great impostor" because of its wide range of clinical symptoms. A high misdiagnosis rate of ischemic stroke was observed among neurosyphilis patients in clinical practice, which prevents patients from receiving the most appropriate treatment, and often results in more severe neurologic damage.

METHODS:

A total of 149 neurosyphilis patients were retrospectively reviewed. The control group comprised 1570 non-neurosyphilitic ischemic stroke patients. The proportion of patients with ischemic stroke as the primary symptom of the different types of neurosyphilis and the misdiagnosis rate of neurosyphilitic ischemic stroke were analyzed, including the risk factors for cardiovascular disease.

RESULTS:

Among the 149 neurosyphilis patients, 21 (14.09%) developed ischemic stroke as a primary symptom, including three cases of syphilitic meningitis and 18 cases of meningovascular neurosyphilis. Only four of the neurosyphilis patients had histories of ischemic stroke and recurrence. The other 17 cases were treated for the first time in the emergency department; however, none of the patients were initially suspected of neurosyphilitic ischemic stroke. All of the patients were only diagnosed with neurosyphilis during their follow-up treatment. The misdiagnosis rate of neurosyphilitic ischemic stroke was as high as 80.95% (17/21). Furthermore, except for hypertension, no significant differences in cardiovascular risk factors were observed between the groups (P>0.05).