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[Progressive paralysis. A case report]

M Trotta1, G Sterrantino, M Meli

  • 1Unità Operativa Malattie Infettive Azienda USL 10, Antella Azienda Ospedaliera Careggi, Firenze.

Minerva Medica
|March 1, 1996
PubMed
Summary
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This case report highlights neurosyphilis in an immunocompetent patient presenting with mania. Early cerebrospinal fluid (CSF) examination is crucial for diagnosing neurosyphilis in patients with new neurological or psychiatric symptoms and reactive syphilis tests.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Psychiatry

Background:

  • Neurosyphilis is a rare complication of syphilis affecting the central nervous system.
  • It can present with diverse neurological and psychiatric symptoms, often mimicking other conditions.
  • Diagnosis can be challenging, especially in immunocompetent individuals without typical risk factors.

Observation:

  • A 40-year-old male, not immunocompromised, presented with recent-onset mania.
  • Initial psychiatric and neurological examinations were unremarkable.
  • Serologic tests for syphilis were positive, with cerebrospinal fluid (CSF) analysis revealing pleocytosis, a reactive Venereal Disease Research Laboratory (VDRL) test, and an abnormal IgG index.

Findings:

  • The patient was diagnosed with general paresis, a form of neurosyphilis.

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  • Treatment with high-dose intravenous penicillin G was administered.
  • Six months post-treatment, CSF normalized, but the IgG index remained abnormal, and mental status was unchanged.

    • Implications:

    • This case underscores the importance of considering neurosyphilis in patients with unexplained neurological or psychiatric symptoms.
    • A reactive VDRL test, even in the absence of typical risk factors, warrants further CSF investigation.
    • Prompt diagnosis and treatment are essential for managing neurosyphilis and preventing long-term complications.