Neurosyphilis in a young adult: very early tertiary syphilis?

Abstract

A rare episode of early neurosyphilis occurred in a 34-year-old, otherwise healthy, woman. Based on an isolated positive Borrelia burgdorferi serology (later interpreted as a cross-reaction), early ceftriaxone was initiated, in the suspect of Lyme borreliosis. Even after the diagnosis was corrected into that of a neurosyphilis, ceftriaxone administration was continued, until it achieved complete clinical and microbiological success after 24 days of treatment in a day-hospital setting, and three-weekly penicillin administrations. When considering the differential diagnosis, a luetic aetiology should not be underestimated when facing young patients with signs-symptoms of a meningoencephalitis. Our case report was characterized by an extremely low patient's age, compared with the occurrence of tertiary neurosyphilis, more than three years after the last sexual contacts. The diagnosis was confirmed by highly positive treponemal and non-treponemal serum and cerebrospinal fluid serology, and several suggestive clinical manifestations: seizures, altered mentation, cognitive impairment, lip drop, and anisochoria. These concomitant findings, together with a neuroradiological report indicating a diffuse meningoencephalitis, allowed us to confirm the diagnosis of neurosyphilis, together with a demonstrated cross-reaction of B. burgdorferi serology. Although ceftriaxone benefits from its once-daily administration (and can be easily delivered on outpatient basis), it is not the firstline treatment of neurosyphilis. However, our experience demonstrated a favourable and rapid response to ceftriaxone, in the absence of toxicity and disease sequelae.

Cocaine-Induced Plasma Cell Orificial “Dermatomucositis”: A More Accurate Descriptive Term for a Clearly Dermatological Entity

“…The presentation of syphilis with involvement of the upper lip is a characteristic clinical profile in the literature, serving as a manifestation of primary syphilis (chancre), secondary syphilis, [4][5][6][7][8][9][10] and even tertiary syphilis. 11,12 In some cases, there may be no evidence of sexual transmission. 13,14 At times, it can be the sole manifestation of the disease.…”

Progressive painless lower limbs weakness in a dialyzed patient: undiagnosed tertiary syphilis: a case report

“…Besides having a high index of suspicion; past medical history of exposure to Treponema pallidum, and physical examination along with serologic tests remained paramount for the diagnosis. Cerebrospinal fluid (CSF) may be helpful, though neurosyphilis with normal CSF cell count in a HIV negative subject has been reported [4]. In addition a negative CSF VDRL cannot exclude it, and FTA-Abs is less specific, but more sensitive.…”