Aim: The purpose of our study was to assess the differences between HIV-negative cryptococcal meningitis (CM) patients with and without autoimmune diseases. Methods: A total of 43 CM patients with autoimmune diseases and 67 without autoimmune diseases were enrolled for analysis. Results: CM patients with autoimmune diseases had higher fever, modified Rankin Scale scores, C-reactive protein and erythrocyte sedimentation rate, but had lower rates of visual and hearing symptoms, ventriculoperitoneal shunts, MRI meningeal enhancement and amphotericin B treatment, as well as lower cerebrospinal fluid pressure and fungal counts. When divided according to gender, each group had lower intracranial pressure and higher inflammation indicators. No differences in outcomes, sequelae and mortality hazard were found. Fluconazole treatment was a prognostic factor for CM without autoimmune diseases. Conclusions: Both antifungal and anti-inflammatory therapy should be considered in CM patients with autoimmune diseases.
Background
The incidence of syphilis has been increasing in recent years, and neurosyphilis can present with various clinical features and magnetic resonance imaging (MRI) findings.
Case presentation
We report a rare case of neurosyphilis in a patient presenting with dizziness, altered mental status, and left limb weakness. MRI revealed changes in the right cingulate gyrus, adjacent frontal lobe cortex and subcortex. The diagnosis of neurosyphilis was confirmed by positive serum Red Unheated Serum Test (TRUST) and Treponema pallidum particle agglutination (TPPA) in cerebrospinal fluid (CSF). Treatment with penicillin G resulted in the disappearance of the lesion and improvement of the patient's clinical condition.
Conclusions
This case report highlights the importance of maintaining a high index of suspicion for neurosyphilis in patients with cingulate gyrus lesions on MRI and atypical neurological symptoms, even in the absence of typical risk factors or clinical manifestations of syphilis.
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