Neurosyphilis is often considered a disease of the past. With early detection and the availability of treatment with Penicillin G, there should be no reason as to why anyone should suffer from the tertiary sequelae of Syphilis. Unfortunately this is not the case and although rare, Neurosyphilis and its devastating side effects still do exist.

Case

The patient is a 50 year old Caucasian male with asthma who was diagnosed with Neurosyphilis approximately eight months prior to presentation. The patient originally presented with mental status changes, confusion and memory loss. He was found to 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 he developed increased confusion, ataxia, and unusual behaviors were reported by his family. An MRI brain at that time showed no abnormalities except for atrophy. His symptoms continued to worsen and he began to have episodes of psychosis. Two months later was re-admitted for a follow-up evaluation. His repeat serum RPR titer was 1:64, and his CSF VDRL titer had decreased to 1:16 indicating a successful treatment response with no need for further antibiotic therapy. His symptoms were consistent with the general paresis form of Neurosyphilis.

Conclusions

References

Neurosyphilis is an infection of the brain and/or spinal cord that occurs in people who have been infected with syphilis, caused by Treponema pallidum, for years that has been untreated. It usually occurs 10-20 years after the patient is first infected; however, it does not occur in all infected persons. Once the bacteria infects the CNS, the body will either clear this infection, or it may present as a transient meningitis. From there, symptoms may persist (early meningitis) or again clear. If the symptoms persist, this will lead to either early symptomatic neurosyphilis, which develops within weeks to months to years, or it may remain dormant and present later as late symptomatic neurosyphilis, which develops over years to decades but is very rare. Early symptomatic neurosyphilis can present with symptoms of meningitis (headache, stiff neck, nausea/vomiting), cranial neuropathies, or occular disease, as well as could lead to a meningovascular stoke. Late symptomatic neurosyphilis then presents as a general paresis (our patient), dementia, personality changes, tabes dorsalis, sensory ataxia, and/or incontinence.

Neurosyphilis is a debilitating disease in all aspects of one’s existence, not only physically but mentally, socially, and emotionally. The natural history of the general paresis form of tertiary Syphilis is progressive decline despite appropriate treatment with IV Penicillin G at the time of diagnosis. Early diagnosis and treatment of Syphilis at the primary or secondary stages of the disease and prevention of tertiary Syphilis are the only effective tools we have against the devastating consequences of general paresis.

Hicks, C.B. (2009). Diagnostic testing for syphlis. Received from: uptodate.com/contents/diagnostic-testing-for-syphilis.

Marra, C.M. (2010). Neurosyphilis. Received from: uptodate.com/contents/neurosyphilis.

Sparling, P.F., Hicks, C.B. (2011). Pathogenesis, clinical manifestations, and treatment of late syphilis. Received from: uptodate.com/contents/pathogenesis-clinical-manifestations-and-treatment-of-late-syphilis.

Timmermans, M., Carr, J. (2004). Neurosyhliis in the modern era. J Neurol Neurosurg Psychiatry 2004;75:1727-1730. Received from: http://jnnp.bmj.com

Kelley Hutchins DO, Ngozi Mezu-Patel MD, Rachael Delahussi MD, Melissa Spera MSIV, Anne Hull MD

LSUHSC New Orleans, LA 70130Introduction

NEUROSYPHILIS IN A 50 YEAR OLD MALE: A Case Report

Discussion

Treponema pallidum by darkfield microscopy

Example of a computed tomorgraphy scan of an 18 year-old patient with dementia; serum VDRL was 1:256; CSF VDRL was positive.