Neurosyphilis in a young adult: very early tertiary syphilis?

2006-05-08 03:59:24 AM
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Neurosyphilis in a young adult: very early tertiary syphilis?
Sabbatani S, Manfredi R, Chiodo F.
Department of Clinical and Experimental Medicine, Division of
Infectious
Diseases, University of Bologna Alma Mater Studiorum, S. Orsola
Hospital,
Via Massarenti II, 1-40138 Bologna, Italy.
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.
Publication Types:
Case Reports
PMID: 16336771 [PubMed - indexed for MEDLINE]
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