1
|
Aytulun A, Grannemann LS, MacKenzie CR, Dimitrakopoulos A, Pessanha‐Schlegel F, Kamp D, Schilbach L. Case report-Depression with psychotic features as an atypical presentation of neurosyphilis. Clin Case Rep 2024; 12:e8836. [PMID: 38689691 PMCID: PMC11059960 DOI: 10.1002/ccr3.8836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Recurrent depression with psychotic features is an atypical presentation of neurosyphilis. This case emphasizes the polymorphic clinical presentation of neurosyphilis and how it mimics affective disorders with psychotic symptoms.
Collapse
Affiliation(s)
- Aykut Aytulun
- Department of General Psychiatry 2, Medical Faculty, LVR‐Klinikum DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Laura Sophie Grannemann
- Department of General Psychiatry 2, Medical Faculty, LVR‐Klinikum DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Colin R. MacKenzie
- Department of MicrobiologyHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Alexandros Dimitrakopoulos
- Department of General Psychiatry 2, Medical Faculty, LVR‐Klinikum DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Francesca Pessanha‐Schlegel
- Department of General Psychiatry 2, Medical Faculty, LVR‐Klinikum DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Daniel Kamp
- Department of General Psychiatry 2, Medical Faculty, LVR‐Klinikum DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
| | - Leonhard Schilbach
- Department of General Psychiatry 2, Medical Faculty, LVR‐Klinikum DüsseldorfHeinrich‐Heine University DüsseldorfDüsseldorfGermany
- Medical FacultyLudwig‐Maximilians‐UniversitätMunichGermany
| |
Collapse
|
2
|
Olatunde H, Anombem OM, Mantha A, Oladunjoye AO, Hudish T. Manic Episodes in a Patient With Neurosyphilis Following Brief Discontinuation of Bipolar Medication. Cureus 2023; 15:e43604. [PMID: 37719591 PMCID: PMC10504430 DOI: 10.7759/cureus.43604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Bipolar disorder is a mood disorder resulting in episodes of either mania or hypomania. The episodes can manifest themselves as a period of abnormally and persistently elevated mood, abnormally and persistently increased activity or energy, distractibility, insomnia, grandiosity, flight of ideas, increased activity, pressured speech, and racing thoughts. Neurosyphilis is a progression of syphilis infection involving the brain, meninges, or spinal cord. The interaction between bipolar disorder and neurosyphilis has not been extensively studied, but it has been theorized that neurosyphilis can exacerbate mood disorders. This case study details a patient with concurrent late-onset bipolar disorder and neurosyphilis and how the discontinuation of bipolar medication resulted in an acute manic episode. In addition, this case underscores the importance of differentiating the presenting symptoms between bipolar disorder and neurosyphilis.
Collapse
Affiliation(s)
- Hafiz Olatunde
- Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, USA
| | | | - Aditya Mantha
- Psychiatry and Behavioral Sciences, The University of Colorado School of Medicine, Aurora, USA
| | - Adeolu O Oladunjoye
- Psychiatry, Baylor College of Medicine, Houston, USA
- Medical Critical Care, Boston Children's Hospital, Boston, USA
| | - Tyler Hudish
- Psychiatry, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, USA
| |
Collapse
|
3
|
Zhou J, Zhang H, Tang K, Liu R, Li J. An Updated Review of Recent Advances in Neurosyphilis. Front Med (Lausanne) 2022; 9:800383. [PMID: 36203756 PMCID: PMC9530046 DOI: 10.3389/fmed.2022.800383] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Neurosyphilis is caused by Treponema pallidum invading the central nervous system, of which the incidence is increasing worldwide. Due to its variable clinical manifestations, diagnosis of neurosyphilis remains challenging, especially the asymptomatic form. This review focuses on recent advances in neurosyphilis, including epidemiology, clinical manifestations, laboratory findings, comorbidities, diagnosis, treatment, prognosis, and basic research. The expansion of men who have sex with men and the infection of human immunodeficiency virus mainly accounted for the increasing incidence of neurosyphilis. The rate of some historically described forms of neurosyphilis in the pre-antibiotic era declined significantly; atypical features are more prevalent. Neurosyphilis, regarded as a great mimicker for neuro-ophthalmic, audio-vestibular, and psychiatric disorders, often presents concomitantly with other diseases, including metabolic disorders. Studies on long non-coding RNAs, miRNAs, chemokines, and metabolites in peripheral blood and cerebrospinal fluid may facilitate exploring the pathogenesis and identifying novel biomarkers of neurosyphilis. The drug resistance of Treponema pallidum to penicillin has not been reported; ceftriaxone was proposed to be more effective than penicillin, whereas few randomized controlled trials supported this view. This study may pave the way for further research, especially the diagnosis and treatment of neurosyphilis.
Collapse
Affiliation(s)
- Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Keyun Tang
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Runzhu Liu
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Jun Li
| |
Collapse
|
4
|
Kapila R, Schwartz RA. Neurosyphilis and the Jarisch-Herxheimer reaction: A therapy concern with HIV disease. Dermatol Ther 2021; 34:e14839. [PMID: 33527658 DOI: 10.1111/dth.14839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
Jarisch-Herxheimer reaction (JHR) should be anticipated in treating neurosyphilis with coexistent human immunodeficiency virus (HIV) encephalitis. In that context we have devised a staging classification for JHR. In addition, an illustrative case is provided to emphasize the need to consider the diagnosis of neurosyphilis in HIV patients, and if delineated, to be prepared for a severe JHR.
Collapse
Affiliation(s)
- Rajendra Kapila
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Medicine, Dermatology, Pathology, and Pediatric, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|