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Neurosyphilis in AIDS patients: initial CSF VDRL may be negative
E R Feraru1, H A Aronow, R B Lipton
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
Neurology
|March 1, 1990
Summary
In HIV patients with neurosyphilis, initial cerebrospinal fluid (CSF) VDRL tests may be negative. Repeated CSF VDRL testing is crucial for diagnosing neurosyphilis in AIDS patients, especially when symptoms persist despite treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Neurosyphilis is a serious complication of syphilis infection.
- Human Immunodeficiency Virus (HIV) infection can alter the presentation and diagnosis of neurosyphilis.
- The Venereal Disease Research Laboratory (VDRL) test is a common cerebrospinal fluid (CSF) biomarker for neurosyphilis.
Observation:
- Two HIV-seropositive patients with suspected neurosyphilis presented with initially negative CSF VDRL tests.
- The first patient's CSF VDRL became positive after 12 days of intravenous penicillin for syphilitic meningitis.
- The second patient developed syphilitic polyradiculopathy and a positive CSF VDRL three months post-IV penicillin treatment.
Findings:
- Initial CSF VDRL tests can be falsely negative in HIV-seropositive patients with neurosyphilis.
- Delayed positivity of CSF VDRL tests can occur even after initiation of appropriate treatment.
- Neurosyphilis diagnosis in HIV-infected individuals may require serial CSF examinations.
Implications:
- Clinicians should consider serial CSF VDRL testing in HIV-positive individuals with suspected neurosyphilis, even with initial negative results.
- Treatment protocols for neurosyphilis in HIV patients may need to account for delayed diagnostic marker seroconversion.
- This highlights the complexity of diagnosing and managing coinfections in immunocompromised populations.