A Case of Early Neurosyphilis

Area of Science:

• Infectious Diseases
• Neurology
• Ophthalmology

Background:

• Neurosyphilis, a central nervous system infection by Treponema pallidum, can manifest in early stages with symptoms like meningitis, meningovascular syphilis, or uveitis.
• While often associated with late-stage syphilis, early neurosyphilis requires prompt recognition and treatment.

Purpose of the Study:

• To report a case of secondary syphilis with early neurosyphilis, presenting with uveitis and skin manifestations.
• To emphasize the importance of considering neurosyphilis in patients with unexplained uveitis and dermatological findings.
• To highlight the management of early neurosyphilis and the potential for Jarisch-Herxheimer reactions.

Main Methods:

• A 28-year-old male with HIV presented with declining visual acuity and a positive RPR test.
• Clinical examination revealed characteristic skin plaques and bilateral uveitis. Cerebrospinal fluid analysis confirmed neurosyphilis.
• Treatment involved intravenous aqueous crystalline penicillin G, followed by benzathine penicillin injections.

Main Results:

• The patient was diagnosed with secondary syphilis and symptomatic early neurosyphilis, characterized by uveitis and skin lesions.
• Cerebrospinal fluid showed lymphocytic pleocytosis with positive VDRL and FTA-ABS.
• The patient experienced a Jarisch-Herxheimer reaction shortly after initiating penicillin treatment, with symptoms resolving within 1-2 days.

Conclusions:

• Secondary syphilis can present with ocular and dermatological manifestations indicative of early neurosyphilis.
• Early neurosyphilis necessitates a prolonged treatment course with penicillin, regardless of the patient's HIV status or syphilis stage.
• The Jarisch-Herxheimer reaction is a significant consideration during the treatment of treponemal infections.