Cases reported "Neurosyphilis"

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1/7. Psychosis or simply a new manifestation of neurosyphilis?

    The widespread use of antibiotics in recent years has caused a significant reduction in the incidence of neurosyphilis and changes in its clinical features. We present a case that initially presented as persistent headache and untreatable psychosis. neurosyphilis was diagnosed during the clinical evaluation. blood serum analyses for syphilis were positive for rapid plasma reagin titres, the Venereal disease research laboratories test and fluorescent treponemal antibody absorption. A lumbar puncture was performed and cerebrospinal fluid analysis resulted in the diagnosis of neurosyphilis. The patient completed a 2-week course of treatment with aqueous crystalline penicillin g and his symptoms subsequently improved. We suggest that neurosyphilis should always be included in the differential diagnosis of untreatable psychosis.
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2/7. Symptomatic relapse of neurologic syphilis after benzathine penicillin g therapy for primary or secondary syphilis in hiv-infected patients.

    We describe 3 symptomatic cases of neurologic syphilis that occurred after the administration of the usual therapy for primary or secondary syphilis in human immunodeficiency virus (hiv)-infected patients. We discuss the difficulty of diagnosing neurosyphilis, the need for lumbar puncture, and risk factors of relapse. Because hiv infection may alter the natural history and response of neurologic syphilis to treatment, scrupulous follow-up and repeated cycles of therapy are warranted.
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3/7. The asymptomatic patient with a positive VDRL test.

    Although VDRL and RPR tests are excellent screens for syphilis, false-positive reactions do occur. A positive VDRL or RPR test must be confirmed with an FTA-ABS test. patients with positive serologic tests should have a thorough physical examination to determine the stage of syphilis. A patient with a low-titer VDRL or RPR may have active disease and may require lumbar puncture to rule out neurosyphilis.
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4/7. Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus.

    Within the past 18 months, we have seen four cases of neurosyphilis at our institution (two of meningovascular syphilis, one of acute syphilitic meningitis, and one of asymptomatic neurosyphilis) in young homosexual men with serologic evidence of exposure to human immunodeficiency virus (hiv). Two of the four patients had neurosyphilis despite previous adequate therapy for early syphilis with benzathine penicillin. Meningovascular syphilis developed in one patient within four months after a primary infection, in a manner consistent with an accelerated course of syphilitic infection. These findings suggest the possibility that hiv infection may alter the natural course of syphilis because of the profound defects in cell-mediated immunity it causes. The possible potentiating effects of hiv on treponema pallidum infection suggest the need for lumbar puncture in the evaluation of hiv-seropositive patients with syphilis, as well as modifications of the currently recommended treatment regimens for primary, secondary, and latent syphilis and neurosyphilis in this patient population. neurosyphilis should probably be added to the growing list of infectious complications of the acquired immunodeficiency syndrome (AIDS) and may be the first such complication to appear.
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5/7. ceftriaxone therapy for asymptomatic neurosyphilis. Case report and Western blot analysis of serum and cerebrospinal fluid IgG response to therapy.

    A 27-year-old man with documented hypersensitivity to penicillin was treated intramuscularly for asymptomatic neurosyphilis with ceftriaxone (1 g daily for 14 days). After treatment the serum titer in the VDRL (Venereal disease research Laboratory) test declined from 32 to four dilutions. Lumbar punctures at months 3, 6, 9, and 28 after treatment revealed normalization of the cell count in cerebrospinal fluid and a decline in the VDRL titer in cerebrospinal fluid from four to one dilution(s). Western blot analysis revealed the presence in serum of IgG antibodies to at least 17 treponemal antigens and in cerebrospinal fluid of antibodies to at least ten treponemal antigens. Following ceftriaxone therapy serum and cerebrospinal fluid IgG reactivity to all antigens steadily decreased in intensity. These results indicate that ceftriaxone may provide a useful alternative therapy for penicillin-allergic patients with neurosyphilis.
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6/7. Asymptomatic neurosyphilis after doxycycline therapy for early latent syphilis.

    A 50-year-old woman allergic to penicillin with early latent syphilis was treated with two courses of doxycycline. Ten months after diagnosis, she had no evidence of serologic response. A lumbar puncture demonstrated asymptomatic neurosyphilis. Penicillin desensitization was performed and she was successfully treated. This case re-emphasizes the need for close serologic follow-up in patients with latent syphilis.
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7/7. Third cranial nerve palsy caused by gummatous neurosyphilis: MR findings.

    The clinical and MR findings in an unusual case of gummatous neurosyphilis are reported. A 44-year-old woman suffering from diplopia and right-sided headaches was admitted. physical examination and routine laboratory parameters were normal except for a third-nerve palsy. MR images revealed a contrast-enhancing lesion of the upper brain stem and third cranial nerve. Differential diagnosis included neuroma of the third cranial nerve, as well as neurosarcoidosis and other inflammatory processes. serologic tests and lumbar puncture revealed the presence of active syphilis. After intravenous treatment with penicillin g, follow-up MR examinations showed diminishing size of the lesion with its complete resolution within 3 months.
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