Neurosyphilis in disguise

Jumah, Ammar; Nour, Hassan Aboul; Alkhoujah, Mohammad; Zoghoul, Sohaib; Eltous, Lara; Miller, Daniel J.

doi:10.1007/s00234-021-02827-3

Cited by 14 publications

(13 citation statements)

References 42 publications

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“…Our findings suggest that in patients with non-specific neurological symptoms and psychotic disorders, neuroimaging can play an important role in indicating suspicion of encephalitis [ 7 ]. Enhancement of anterior parts of the temporal lobe is an atypical imaging finding, which can simulate an infection with herpes simplex virus, which is also the most common differential diagnosis of syphilitic encephalitis [ 8 ]. Typical findings of neurosyphilis and herpes simplex virus encephalitis can be indistinguishable on MRI and include unilateral or bilateral MRI hyperintensities in the mesiotemporal lobes on T2-weighted imaging or FLAIR imaging.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

et al. 2022

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Patient: Male, 49-year-old Final Diagnosis: Neurosyphilis Symptoms: Behavioral disturbance • confusion • disorientation • hallucinations • memory loss Medication: Penicillin G • acyclovir Clinical Procedure: Lumbar puncture Specialty: Infectious Diseases • Neurology • Radiology Objective: Rare disease Background: Neurosyphilis is a central nervous system infection caused by Treponema pallidum , that can develop at any time after the initial infection. The clinical signs of neurosyphilis are very variable, as well as its radiological features, and it is a diagnostic challenge. Knowledge of clinical symptoms and correct laboratory diagnostics, combined with routine radiological examination and additional diagnostic tools, such as high-resolution, three-dimensional FLAIR sequence, T2-weighted, and T1-weighted contrast-enhanced magnetic resonance imaging (MRI) are key to making an accurate diagnosis of neurosyphilis. Case Report: We present the clinical case of a patient who presented a 1-year history of vague clinical symptoms and was misdiagnosed with herpes simplex virus (HSV) encephalitis. Initial head MRI revealed extensive cerebral white matter lesions with cortical contrast enhancement, mainly of anterior and medial parts of the left temporal lobe, as typically seen in HSV encephalitis. Empirical therapy with acyclovir was started until a diagnosis of syphilis was confirmed with laboratory findings. Later, the therapy was changed to penicillin G. The patient’s condition improved after receiving targeted treatment. A control MRI scan was performed, and previously detected changes in the brain had decreased significantly. Conclusions: MRI is the imaging of choice to support the diagnosis of neurosyphilis. Our findings suggest that neuroimaging can play an important role in indicating suspicion of syphilitic encephalitis. Enhancement of the anterior and medial parts of the temporal lobe is an atypical imaging finding, and it can simulate an infection with HSV. Early treatment is critical to a positive outcome.

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Section: Discussionmentioning

confidence: 99%

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

et al. 2022

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“…14 Nevertheless, other central nervous system diseases from virus infection, Alzheimer’s disease, and ischemic stroke may have similar changes, which may have little significance for etiological diagnosis. 15 Therefore, the clinical laboratory-related neurosyphilis screening indicators play an irreplaceable role in the diagnosis of neurosyphilis. However, the diagnosis of neurosyphilis is still a great challenge, especially in the differential diagnosis of neurosyphilis and latent syphilis infection in the central nervous system, there is a lack of effective diagnostic markers.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Changes and Clinical Features of Neurosyphilis Compared with Latent Syphilis Infection in the Central Nervous System: A Cross-Sectional Study

Ge¹,

Gou²,

Dong³

et al. 2022

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Purpose At present, there is no gold standard or unified standard for the diagnosis of neurosyphilis, and the rate of misdiagnosis is high. The diagnosis of neurosyphilis is still challenging. This study compared the clinical indicators between neurosyphilis and latent syphilis infection in the central nervous system. The purpose of this study was to provide evidence for the differential diagnosis and prognosis of patients with neurosyphilis and latent syphilis infection of the central nervous system. Methods The clinical data of 59 patients with neurosyphilis and 30 patients with latent syphilis infection in the nervous system from 2008 to 2021 were analyzed. The cerebrospinal fluid and serum biochemical markers were evaluated for all patients. Results CSF-nucleated cells, CSF-TRUST, CSF-totalprotein and CSF-IgG ( P <0.001) were significantly different between neurosyphilis and latent syphilis infection in the central nervous system. CSF-TRUST titer was positively correlated with D-D concentration ( r = 0.274, P < 0.05), sodion ( r =0.251, P < 0.05), respectively. Glucose concentration is the most unreliable in the diagnosis of neurosyphilis (AUC=0.445, P =0.395), and TRUST combined with nucleated cells and total protein is the most accurate in the diagnosis of neurosyphilis (AUC=0.989, P <0.001). Conclusion The combination of TRUST, nucleated cell count and totalprotein detection in CSF can distinguish the patients with neurosyphilis and latent syphilis infection in the central nervous system, which has a significant diagnostic value.

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“…Bei etwa 75% der asymptomatischen Patienten zeigt sich ein unauffälliges cMRT oder eine unspezifische zerebrale Atrophie [17]. Im Falle einer parenchymatösen Neurosyphilis sind unabhängig vom Auftreten in der frühen oder späten Phase der Erkrankung sowohl bilaterale als auch asymmetrische mesiotemporal lokalisierte FLAIR-und T2-Hyperintensitäten mehrfach beschrieben [18]. Aber auch davon abweichende Lokalisationen wie z.…”

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“…Häufigster Befund sind intramedulläre T2-Hyperintensitäten mit Kontrastmittelaufnahme in T1. Eine spinale Atrophie ist mit einer schlechteren Prognose assoziiert [18]. -…”

Section: Bildgebungunclassified

“…Im Spätstadium der progressiven Paralyse ist der häufigste MR-morphologische Befund eine kortikale Atrophie begleitet von einem variablen Maß einer zusätzlichen regionalen Atrophie frontal, temporoparietal lobär, hippocampal sowie im Corpus callosum und ebendort lokalisierter Hyperintensitäten (FLAIR und T2). Besonders häufig ist eine mediale temporale Atrophie verbunden mit einer schlechteren Prognose [18].…”

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Neurolues

Hähn

Maschke

2022

Neurologie up2date

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Die Diagnose einer Neurosyphilis stellt häufig eine Herausforderung dar. Schon Arthur Conan Doyle (1859–1930), der den meisten Menschen durch seine Kriminalgeschichten um den fiktiven Detektiv Sherlock Holmes bekannt ist, hat für sein Medizinstudium eine Abschlussarbeit zur Tabes dorsalis verfasst. Man kann vermuten, dass es Parallelen zwischen dem kriminalistischen und diagnostischen Vorgehen gibt.

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Neurosyphilis in disguise

Cited by 14 publications

References 42 publications

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

Cerebrospinal Fluid Changes and Clinical Features of Neurosyphilis Compared with Latent Syphilis Infection in the Central Nervous System: A Cross-Sectional Study

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