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[Cutaneous tertiary syphilis with neurological symptoms]
C Drobacheff1, T Moulin, H Van Landuyt
1Service de Dermatologie II, CHU Saint-Jacques, Besançon.
Annales De Dermatologie Et De Venereologie
|January 1, 1994
Summary
Tertiary cutaneous syphilis is rare, presenting diagnostic challenges for neurosyphilis. This case highlights difficulties in interpreting serologic and cerebrospinal fluid tests for accurate diagnosis and treatment.
Area of Science:
- Infectious Diseases
- Neurology
- Dermatology
Background:
- Tertiary cutaneous syphilis is exceptionally rare.
- Neurosyphilis diagnosis is complicated by atypical presentations and serological test interpretation challenges.
- This case underscores the diagnostic complexities in tertiary syphilis with neurological involvement.
Observation:
- A 63-year-old woman presented with nodular, purplish cutaneous lesions and neurological dysfunction, including tremors and cognitive decline.
- Biopsy revealed lymphoplasmocytic granuloma with endothelitis, and syphilis serologic tests were highly positive.
- Cerebrospinal fluid analysis showed no abnormalities, complicating the neurosyphilis diagnosis despite clinical symptoms.
Findings:
- Despite positive systemic syphilis serology, CSF VDRL was negative, and there was no pleocytosis or elevated protein.
- Intravenous penicillin G treatment led to regression of cutaneous lesions but no improvement in neurological status.
- Six months post-treatment, neurological symptoms persisted, with changes in syphilis antibody titers.
Implications:
- The case highlights the diagnostic challenges in neurosyphilis, particularly when CSF findings are inconclusive.
- It raises questions about the optimal treatment regimens and follow-up protocols for neurological syphilis.
- Accurate interpretation of serological and CSF tests is crucial for managing complex syphilis cases.