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NEUROSYPHILIS IN A 50 YEAR OLD MALE:

A Case Report
Kelley Hutchins DO, Ngozi Mezu-Patel MD, Rachael Delahussi MD, Melissa Spera MSIV,
Anne Hull MD
LSUHSC New Orleans, LA 70130
Introduction Discussion Conclusions
Neurosyphilis is often considered a disease of Neurosyphilis is an infection of the brain and/or spinal cord that Neurosyphilis is a debilitating disease in all aspects
the past. With early detection and the occurs in people who have been infected with syphilis, caused by of ones existence, not only physically but mentally,
availability of treatment with Penicillin G, there Treponema pallidum, for years that has been untreated. It usually socially, and emotionally. The natural history of the
should be no reason as to why anyone should occurs 10-20 years after the patient is first infected; however, it general paresis form of tertiary Syphilis is
suffer from the tertiary sequelae of Syphilis. does not occur in all infected persons. Once the bacteria infects the progressive decline despite appropriate treatment
Unfortunately this is not the case and although CNS, the body will either clear this infection, or it may present as a with IV Penicillin G at the time of diagnosis. Early
rare, Neurosyphilis and its devastating side transient meningitis. From there, symptoms may persist (early diagnosis and treatment of Syphilis at the primary or
effects still do exist. meningitis) or again clear. If the symptoms persist, this will lead to secondary stages of the disease and prevention of
either early symptomatic neurosyphilis, which develops within tertiary Syphilis are the only effective tools we have
weeks to months to years, or it may remain dormant and present against the devastating consequences of general
Case later as late symptomatic neurosyphilis, which develops over years paresis.
to decades but is very rare. Early symptomatic neurosyphilis can
The patient is a 50 year old Caucasian male
present with symptoms of meningitis (headache, stiff neck,
with asthma who was diagnosed with
nausea/vomiting), cranial neuropathies, or occular disease, as well
Neurosyphilis approximately eight months
as could lead to a meningovascular stoke. Late symptomatic
prior to presentation. The patient originally
neurosyphilis then presents as a general paresis (our patient),
presented with mental status changes,
dementia, personality changes, tabes dorsalis, sensory ataxia,
confusion and memory loss. He was found to
and/or incontinence.
be serum RPR positive with a titer of 1:512, and
CSF studies revealed a VDRL titer of 1:128. He
was treated with two weeks of IV penicillin G,
and his neurological symptoms slightly
improved. However, over the next six months Treponema pallidum by darkfield microscopy
he developed increased confusion, ataxia, and Example of a computed
unusual behaviors were reported by his family. tomorgraphy scan of an References
An MRI brain at that time showed no 18 year-old patient with
dementia; serum VDRL Hicks, C.B. (2009). Diagnostic testing for syphlis. Received
abnormalities except for atrophy. His
was 1:256; CSF VDRL from: uptodate.com/contents/diagnostic-testing-for-syphilis.
symptoms continued to worsen and he began
was positive. Marra, C.M. (2010). Neurosyphilis. Received from:
to have episodes of psychosis. Two months
uptodate.com/contents/neurosyphilis.
later was re-admitted for a follow-up evaluation.
His repeat serum RPR titer was 1:64, and his Sparling, P.F., Hicks, C.B. (2011). Pathogenesis, clinical
CSF VDRL titer had decreased to 1:16 manifestations, and treatment of late syphilis. Received
indicating a successful treatment response from: uptodate.com/contents/pathogenesis-clinical-
manifestations-and-treatment-of-late-syphilis.
with no need for further antibiotic therapy. His
symptoms were consistent with the general Timmermans, M., Carr, J. (2004). Neurosyhliis in the modern
paresis form of Neurosyphilis. era. J Neurol Neurosurg Psychiatry 2004;75:1727-1730.
Received from: http://jnnp.bmj.com

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