Syphilitic meningitis causing paraparesis in an HIV-negative woman

Byrne, Thomas N.; Bose, Arani; Sze, G; Sg, Waxman

doi:10.1016/0022-510x(91)90282-c

Cited by 14 publications

(6 citation statements)

References 7 publications

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“…3,[9][10][11] The efficacy of the recommended therapy for patients with early syphilis who are not infected with HIV was also questioned 12 ; after this therapy neurosyphilis was reported and Treponema pallidum was isolated from the cerebrospinal fluid of patients not known to be HIV-infected. [13][14][15][16] Although experience suggested that syphilis treatment rarely failed in patients not infected with HIV, data on the matter had not been systematically collected. 17,18 We evaluated the effectiveness of the CDC-recommended treatment for early syphilis in patients with and without HIV infection by comparing that treatment with the same regimen enhanced by the addition of amoxicillin and probenecid.…”

Section: Resultsmentioning

confidence: 99%

A Randomized Trial of Enhanced Therapy for Early Syphilis in Patients with and without Human Immunodeficiency Virus Infection

et al. 1997

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After treatment for primary or secondary syphilis, the HIV-infected patients responded less well serologically than the patients without HIV infection, but clinically defined failure was uncommon in both groups. Enhanced treatment with amoxicillin and probenecid did not improve the outcomes. Although T. pallidum was detected in cerebrospinal fluid before therapy in a quarter of the patients tested, such a finding did not predict treatment failure. The current recommendations for treating early syphilis appear adequate for most patients, whether or not they have HIV infection.

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Section: Resultsmentioning

confidence: 99%

A Randomized Trial of Enhanced Therapy for Early Syphilis in Patients with and without Human Immunodeficiency Virus Infection

et al. 1997

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“…Its most common clinical presentation includes tabes dorsalis and general paresis [ 2,3]. In contrast, polyradiculoneuritis has seldom been reported during syphilis [ 4–6]. We thus report a case of subacute polyradiculoneuritis caused by Treponema pallidum in an HIV‐negative man and review the other cases.…”

Section: Description Of Four Patients With Polyradiculoneuritis Causementioning

confidence: 99%

“…Two other cases have been recently described in HIV‐negative patients. In one, polyradiculopathy occurred simultaneously with a maculopapular rash [ 5]. In the other, a tertiary or late symptomatic neurosyphilis presented as a motor polyradiculoneuropathy without any previous skin rash [ 6].…”

Section: Description Of Four Patients With Polyradiculoneuritis Causementioning

confidence: 99%

Subacute polyradiculoneuritis revealing syphilis in an HIV-negative man

Darras-Joly

Bélec

Lortholary

2000

Clinical Microbiology and Infection

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“…One case was treated with PCN and plasmapheresis with initial improvement; however, the patient was also lost to followup. The remaining two cases were treated with fever therapy, and both showed moderate recovery [3][4][5][6][7][8][9][10][11]. Additionally, recent literature has shown GBS associated with coronavirus disease 2019 (COVID-19) vaccinations from multiple pharmaceutical companies [12].…”

Section: Introductionmentioning

confidence: 99%

Looks Like Neurosyphilis, Feels Like Guillain-Barre: At the Confluence of Infection and Immunology

Berger¹,

Vernon²,

Abdo³

et al. 2022

Cureus

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We present a 51-year-old male, with a past medical history of type 2 insulin-dependent diabetes mellitus (T2IDDM) without neuropathy, coronavirus disease 2019 in April 2020 without residual symptoms, Raynaud's, and recent occupational outdoor exposure to insects as a construction manager who came to the emergency room complaining of a three-week history of bilateral progressive numbness and weakness beginning in his lower extremities and ascending toward his pelvis. Notably, he received the second dose of his Moderna COVID-19 vaccine one week prior to symptom onset and four weeks prior to admission. He also reported a recent appearance of a maculopapular rash on his upper extremities and flanks. Physical exam was remarkable for bilateral distal motor weakness in the upper and lower extremities with associated paresthesia and decreased reflexes in the lower extremities. The patient had slight ataxia and difficulty with heel walk and toe walk. Notably, the cranial nerve exam was normal, and the patient was afebrile. Intravenous immune globulin (IVIG) was started empirically for the treatment of Guillain-Barre syndrome (GBS), and doxycycline 100mg intravenous twice a day and ceftriaxone 2g intravenous daily were started for possible tick-borne disease. Subsequently, rapid plasma reagin (RPR) returned reactive at 1:64, and cerebral spinal fluid (CSF) venereal disease research laboratory (VDRL) test was reactive at 1:2 with markedly elevated protein and pleocytosis. Human immunodeficiency virus (HIV) testing was negative. Lyme disease testing was negative. Nerve conduction studies (NCS) and electromyography (EMG) showed a sensorimotor polyneuropathy with mixed demyelinating and axonal features. IVIG was continued for a total of five days, and antibiotics were changed to penicillin G (PCN G) for a total of 14 days for definitive treatment of early neurosyphilis (NS). While both clinical and laboratory findings confirm a positive diagnosis of NS, the patient's CSF composition showed very elevated total protein levels and pleocytosis. Additionally, his early peripheral neuropathy and EMG findings are not characteristics of a single disease and, instead, suggested a mixed pathology. We postulate that this patient had confirmed secondary syphilis with early NS associated with, and possibly correlated with, a simultaneous episode of acute inflammatory demyelinating polyneuropathy (AIDP) and/or a vaccine-related phenomenon.

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Syphilitic meningitis causing paraparesis in an HIV-negative woman

Cited by 14 publications

References 7 publications

A Randomized Trial of Enhanced Therapy for Early Syphilis in Patients with and without Human Immunodeficiency Virus Infection

A Randomized Trial of Enhanced Therapy for Early Syphilis in Patients with and without Human Immunodeficiency Virus Infection

Subacute polyradiculoneuritis revealing syphilis in an HIV-negative man

Looks Like Neurosyphilis, Feels Like Guillain-Barre: At the Confluence of Infection and Immunology

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