Institute of Tropical Medicine Antwerp
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The big imitator strikes again: a case report of neurosyphilis in a patient with newly diagnosed HIV [case report]

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Show simple item record de Bruijn, S. en_US Kenyon, C. en_US Leonard, N. en_US Vlieghe, E. en_US 2017-12-18T12:55:38Z 2017-12-18T12:55:38Z 2017 en_US
dc.identifier.issn 1784-3286 en_US
dc.identifier.doi en_US
dc.identifier.other en_US
dc.identifier.other ITG-C2A; ITG-CLA; DCS; U-STINF; U-UZA; JIF; DOI; CPDF; Abstract; DSPACE64 en_US
dc.description.abstract BACKGROUND: Neurosyphilis is the result of an infection of the central nervous system caused by the spirochete Treponema pallidum. Its clinical presentation includes meningovascular syphilis, tabes dorsalis, and dementia paralytica, resulting in a wide range of symptoms such as psychosis, Parkinsonism, and depression. CASE REPORT: A 49-year-old male was admitted to a psychiatric hospital because of social withdrawal and self-neglect, indicative of a major depression. A routine HIV-test was positive and resulted in an admission to the Antwerp University Hospital. Clinical examination showed Argyll Robertson pupils, a wide-based gait, absence of vibration sense in the lower limbs, and a MMSE-score of 25/30. Blood analysis revealed a CD4+ count of 99 cells/muL and a HIV viral load of 2,13 x 105 copies/mL plasma. A serum TPHA (T. pallidum hemagglutination assay) titre of 1/20480 and RPR (rapid plasma reagin) titre of 1/128 were detected. TPHA and RPR titre in the cerebrospinal fluid were, respectively, 1/10240 and 1/4. A brain MRI showed diffuse cortical atrophy and lesions in the white matter compatible with HIV-encephalopathy. The diagnoses of advanced HIV-infection and late neurosyphilis were made. HAART (highly active antiretroviral therapy) and high-dose IV penicillin G were started. CONCLUSION: In all patients with new-onset dementia or untreatable psychosis, neurosyphilis should always be considered. Argyll Robertson pupils are regarded as pathognomonic of neurosyphilis. The management of neurosyphilis includes high-dose IV benzyl penicillin for 10 to 14 days. Close follow-up including a lumbar puncture after 6 months is warranted to ensure treatment recovery. en_US
dc.language English en_US
dc.relation.uri en_US
dc.subject Neurosyphilis en_US
dc.subject Neurological disorders en_US
dc.subject Case reports en_US
dc.subject Belgium en_US
dc.subject Europe-West en_US
dc.title The big imitator strikes again: a case report of neurosyphilis in a patient with newly diagnosed HIV [case report] en_US
dc.type Article en_US
dc.citation.issue 5 en_US
dc.citation.jtitle Acta Clinica Belgica en_US
dc.citation.volume 72 en_US
dc.citation.pages 372-374 en_US
dc.citation.abbreviation Acta Clin Belg en_US

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