Concurrent aquaporin-4-positive NMOSD and neurosyphilis: A case report

Chen, Huaqiu; Zhang, Ying; Wang, Si-Bo; Song, Yanna; Bai, Miao-Shui; Liu, Kangding; Zhu, Mingqin

doi:10.1016/j.msard.2019.06.028

Cited by 5 publications

(11 citation statements)

References 19 publications

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“…So, we hypothesized that the state of neurosyphilis was not the same as the immunocompromised state of HIV patients. Additionally, T. pallidum can cause chronic inflammation and invade the CNS via the blood, leading to destruction of the blood–CSF barrier, disintegration of myelin, and loss of nerve fibers[ 18 ]. The most common forms of neurosyphilis involving the spinal cord are tabes dorsalis and syphilitic myelitis[ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…TB and syphilis are common in the clinical setting; however, the involvement of CNS is rare. T. pallidum can invade the CNS via the blood and cause chronic inflammation, leading to the destruction of the blood–brain barrier[ 18 ]. The breakdown of the blood–brain barrier makes it easier for other pathogens, such as MTB and Cryptococcus , to enter the CNS.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous cases, the typical MRI appearance of syphilitic myelitis is abnormal enhancement in the superficial parts of the spinal cord parenchyma (candle guttering appearance) and reversed signal intensities on T2-weighted images and gadolinium-enhanced T1-weighted images (flip-flop sign)[ 15 - 17 ]. It is now widely accepted that neurosyphilis can coexist with many diseases, including human immunodeficiency virus (HIV) infection, cryptococcal meningitis, tuberculous meningitis, neuromyelitis optica (NMO), and N-methyl-D-aspartate-receptor encephalitis[ 18 - 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Here, we report a case in which neurosyphilis coexisted with tuberculous myelitis. The speciﬁc mechanism might be that T. pallidum destroys the blood–brain barrier and the patient is more likely to have other CNS infections[ 18 ]. Additionally, the potential association between neurosyphilis and tuberculous myelitis will be discussed in detail.…”

Section: Introductionmentioning

confidence: 99%

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Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Gu¹,

Tian²,

Yan³

2021

WJCC

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BACKGROUND Tuberculous myelitis is a rare manifestation of tuberculosis (TB) that is usually caused by hematogenous spread of Mycobacterium tuberculosis (MTB). Neurosyphilis is a neurological disease that occurs when Treponema pallidum invades the brain or the spinal cord. Individually, these two diseases involving the spinal cord are rare and cases of concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis have seldom been reported. CASE SUMMARY A 56-year-old man presented with numbness and pain of both lower limbs for 2 wk and dysuria for 1 wk. Syphilis serology and cerebrospinal fluid (CSF) analysis supported the diagnosis of neurosyphilis and the patient was treated with intravenous ceftriaxone at first, but symptoms still progressed. Then, magnetic resonance images revealed multiple lesions along the cervicothoracic junction, and chest computed tomography showed a typical TB lesion. MTB DNA was detected in the CSF sample by metagenomic next-generation sequencing. Eventually the patient was diagnosed with tuberculous myelitis combined with asymptomatic neurosyphilis. Subsequently, quadruple anti-TB drug standardized therapy was empirically used and his neurological symptoms improved gradually. CONCLUSION Patients can have coinfection with tuberculous transverse myelitis and asymptomatic neurosyphilis. Patients with neurosyphilis should be examined for other pathogens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Gu¹,

Tian²,

Yan³

2021

WJCC

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“…NA-AION has also been reported with Lyme disease (a disease caused by Borrelia burgdorferi, a spirochete like T. pallidum) [24]. Syphilis can arguably trigger or cause an immune-mediated optic neuropathy like seropositive and seronegative variants of neuromyelitis optica spectrum disorder (NMOSD), which has been reported in several articles with ocular and or neurosyphilis [25][26][27][28], or NMDAR antibody encephalitis [29]. Other differentials for painless loss of vision include Leber's hereditary ON (LHON) [14].…”

Section: Discussionmentioning

confidence: 99%

Ocular Syphilis Presenting As Non-arteritic Anterior Ischemic Optic Neuropathy

Alqurashi

Badr

Bukhari

2021

Cureus

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Syphilis is a sexually transmitted disease caused by the spirochetal bacteria Treponema pallidum. It can cross the blood-brain barrier within days of the infection, causing neurosyphilis and ocular syphilis at any stage of the disease. Ocular syphilis can manifest in any part of the eye but usually as posterior uveitis and panuveitis or various types of inflammatory or immune-mediated optic neuritis. Misdiagnosing ocular syphilis as a non-infectious disease has been reported even when seen by ophthalmologists due to the wide variety of possible presentations. In this case report, we describe a case of ocular syphilis that presented with a nonarteritic anterior ischemic optic neuropathy (NA-AION), which to our knowledge, has not been described before in the literature.

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Neurosyphilis complicated by anti-γ-aminobutyric acid-B receptor encephalitis: A case report

Fang,

Zhou,

Zheng

et al. 2024

World J Clin Cases

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BACKGROUND Syphilis is an infectious disease caused by Treponema pallidum that can invade the central nervous system, causing encephalitis. Few cases of anti-N-methyl-D-aspartate receptor autoimmune encephalitis (AE) secondary to neurosyphilis have been reported. We report a neurosyphilis patient with anti-γ-aminobutyric acid-B receptor (GABABR) AE. CASE SUMMARY A young man in his 30s who presented with acute epileptic status was admitted to a local hospital. He was diagnosed with neurosyphilis, according to serum and cerebrospinal fluid (CSF) tests for syphilis. After 14 d of antiepileptic treatment and anti-Treponema pallidum therapy with penicillin, epilepsy was controlled but serious cognitive impairment, behavioral, and serious psychiatric symptoms were observed. He was then transferred to our hospital. The Mini-Mental State Examination (MMSE) crude test results showed only 2 points. Cranial magnetic resonance imaging revealed significant cerebral atrophy and multiple fluid-attenuated inversion recovery high signals in the white matter surrounding both lateral ventricles, left amygdala and bilateral thalami. Anti-GABABR antibodies were discovered in CSF (1:3.2) and serum (1:100). The patient was diagnosed with neurosyphilis complicated by anti-GABABR AE, and received methylprednisolone and penicillin. Following treatment, his mental symptoms were alleviated. Cognitive impairment was significantly improved, with a MMSE of 8 points. Serum anti-GABABR antibody titer decreased to 1:32. The patient received methylprednisolone and penicillin after discharge. Three months later, the patient’s condition was stable, but the serum anti-GABABR antibody titer was 1:100. CONCLUSION This patient with neurosyphilis combined with anti-GABABR encephalitis benefited from immunotherapy.

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Concurrent aquaporin-4-positive NMOSD and neurosyphilis: A case report

Cited by 5 publications

References 19 publications

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Concurrent tuberculous transverse myelitis and asymptomatic neurosyphilis: A case report

Ocular Syphilis Presenting As Non-arteritic Anterior Ischemic Optic Neuropathy

Neurosyphilis complicated by anti-γ-aminobutyric acid-B receptor encephalitis: A case report

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