Rapidly Progressive Tabes Dorsalis Associated with Selective IgA Deficiency.

Nishimura, Satoshi; Miura, Hideaki; Yamada, Hideaki; Ryu, Tomiko; Miura, Yasusada

doi:10.2169/internalmedicine.40.972

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…An anecdotal exception could be represented by a literature report of rapidly progressive tabes dorsalis that occurred in a 28-year-old patient with an IgA immunodeficiency. 7 A low clinical suspicion due to the young age, negative syphilis testing obtained a decade before, negligible recent sexual history, absence of CSF leukocytes, and the need to exclude all other possible aetiologies hampered a prompt recognition of tertiary neurosyphilis in our case. The possible cross-reaction of syphilis and borrelia serology 8,9 also contributed to delay both recognition and selective treatment of neurosyphilis.…”

Section: Discussionmentioning

confidence: 82%

“…The ceftriaxone-tetracycline association, started when neuroborreliosis was still suspected, 9 is not the first-choice neurosyphilis therapy, although both cefriaxone and tetracyclines may act favourably in patients with primary-secondary syphilis, 3,5 and in tertiary CNS localizations too. [5][6][7]11,12 This is due to the favourable antimicrobial activity associated with elevated CNS penetration of ceftriaxone. Presently, the main penicillin alternative remains doxycycline, and the place of ceftriaxone and azithromycin, although promising, cannot be established due to the lack of randomized trials.…”

Section: Discussionmentioning

confidence: 99%

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Neurosyphilis in a young adult: very early tertiary syphilis?

2005

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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.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Neurosyphilis in a young adult: very early tertiary syphilis?

2005

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“…In 2001, Nishimura et al . reported a 28‐year‐old man with rapidly progressive tabes dorsalis associated with selective IgA deficiency 12 . They suggested that ‘the atypical rapid course of this patient was possibly due to this selective IgA deficiency’.…”

Section: Discussionmentioning

confidence: 98%

Extensive annular verrucous late secondary syphilis

Pournaras¹,

Masouyé²,

Piletta³

et al. 2005

Br J Dermatol

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We report an illustrative case of an apparently healthy 38-year-old man with a past history of alopecia universalis who developed extensive, slightly pruritic, infiltrated annular verrucous lesions of the scalp, perioral, lumbar, perianal and genital areas over a 6-month period. The combination of an unusual clinical presentation, positive syphilis serology and rapid response to penicillin therapy was consistent with a diagnosis of extensive annular and verrucous late secondary syphilis. We present this case to illustrate a rare and potentially misleading clinical feature of late secondary syphilis, a disease considered to be of the past but still present in today's practice.

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“…tabes -разложение, тление, гниение), в допенициллиновую эпоху считалась патогномоничной и самой распространенной формой НС. После внедрения в практику пенициллина СС регистрировалась казуистически редко, однако в последние годы сообщения о случаях данной патологии все чаще появляются как в отечественной [14][15][16][17][18][19], так и в зарубежной [20][21][22] литературе. Имеются также единичные сообщения о СС у инфицированных ВИЧ [23,24].…”

Section: Discussionunclassified

Tabes dorsalis associated with progressive HIV infection: a case history and review of the literature

Krasnoselskikh¹,

Manasheva²,

Lonshakova-Medvedeva³

et al. 2019

Klin. dermatol. venerol.

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Описан редкий случай спинной сухотки у мужчины 66 лет с впервые выявленной ВИЧ-инфекцией (стадия 4В). Поздний нейросифилис (НС) и ВИЧ-инфекция были диагностированы у пациента одновременно при обследовании в связи с жалобами на снижение слуха, слабость мимической мускулатуры правой половины лица, нарушение походки. Спинная сухотка проявлялась невритами n. vestibulocochlearis и n. facialis, сухожильной гипорефлексией, положительным симптомом Аргайла Робертсона, статической и двигательной атаксией. Неврологическая симптоматика соответствовала началу атактической стадии спинной сухотки. Диагноз был подтвержден результатами исследования цереброспинальной жидкости. Пациенту было назначено лечение массивными дозами внутривенно вводимого пенициллина, однако возникшая на 12-й день лечения токсикодермия потребовала замены препарата на антибиотики резерва. На фоне специфического лечения было отмечено уменьшение неустойчивости при ходьбе, но положительной динамики со стороны органа слуха и симптомов прозопареза не было. ВИЧ-инфекция без антиретровирусной терапии прогрессировала, и спустя 3,5 мес пациент скончался вследствие двусторонней субтотальной пневмоцистной пневмонии. Описанный случай представляет интерес в связи с редкостью tabes dorsalis и необычно быстрым нарастанием неврологической симптоматики на фоне прогрессирующей ВИЧ-инфекции. В ближайшие годы прогнозируется увеличение числа случаев коинфекции Treponema pallidum и ВИЧ и, следовательно, у ВИЧ-инфицированных пациентов возможно более частое развитие поздних форм НС.

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Rapidly Progressive Tabes Dorsalis Associated with Selective IgA Deficiency.

Cited by 4 publications

References 9 publications

Neurosyphilis in a young adult: very early tertiary syphilis?

Neurosyphilis in a young adult: very early tertiary syphilis?

Extensive annular verrucous late secondary syphilis

Tabes dorsalis associated with progressive HIV infection: a case history and review of the literature

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