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Fang YX, Zhou XM, Zheng D, Liu GH, Gao PB, Huang XZ, Chen ZC, Zhang H, Chen L, Hu YF. Neurosyphilis complicated by anti-γ-aminobutyric acid-B receptor encephalitis: A case report. World J Clin Cases 2024; 12:1960-1966. [PMID: 38660543 PMCID: PMC11036513 DOI: 10.12998/wjcc.v12.i11.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/25/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Syphilis is an infectious disease caused by Treponema pallidum that can invade the central nervous system, causing encephalitis. Few cases of anti-N-methyl-D-aspartate receptor autoimmune encephalitis (AE) secondary to neurosyphilis have been reported. We report a neurosyphilis patient with anti-γ-aminobutyric acid-B receptor (GABABR) AE. CASE SUMMARY A young man in his 30s who presented with acute epileptic status was admitted to a local hospital. He was diagnosed with neurosyphilis, according to serum and cerebrospinal fluid (CSF) tests for syphilis. After 14 d of antiepileptic treatment and anti-Treponema pallidum therapy with penicillin, epilepsy was controlled but serious cognitive impairment, behavioral, and serious psychiatric symptoms were observed. He was then transferred to our hospital. The Mini-Mental State Examination (MMSE) crude test results showed only 2 points. Cranial magnetic resonance imaging revealed significant cerebral atrophy and multiple fluid-attenuated inversion recovery high signals in the white matter surrounding both lateral ventricles, left amygdala and bilateral thalami. Anti-GABABR antibodies were discovered in CSF (1:3.2) and serum (1:100). The patient was diagnosed with neurosyphilis complicated by anti-GABABR AE, and received methylprednisolone and penicillin. Following treatment, his mental symptoms were alleviated. Cognitive impairment was significantly improved, with a MMSE of 8 points. Serum anti-GABABR antibody titer decreased to 1:32. The patient received methylprednisolone and penicillin after discharge. Three months later, the patient's condition was stable, but the serum anti-GABABR antibody titer was 1:100. CONCLUSION This patient with neurosyphilis combined with anti-GABABR encephalitis benefited from immunotherapy.
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Affiliation(s)
- Ya-Xiu Fang
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Xiao-Ming Zhou
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Dong Zheng
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Guang-Hui Liu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China
| | - Peng-Bo Gao
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Xiao-Zhen Huang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China
| | - Zhi-Cheng Chen
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Hui Zhang
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Lin Chen
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Ya-Fang Hu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China
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Bien CI, Nehls F, Kollmar R, Weis M, Steinke W, Woermann F, Dalmau J, Bien CG. Identification of adenylate kinase 5 antibodies during routine diagnostics in a tissue-based assay: Three new cases and a review of the literature. J Neuroimmunol 2019; 334:576975. [PMID: 31177032 DOI: 10.1016/j.jneuroim.2019.576975] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/03/2023]
Abstract
Antibodies against adenylate kinase 5 (AK5) have been described in patients with non-paraneoplastic limbic encephalitis, mainly in men around 70 years of age. Routine testing with specific cell-based assays is not yet available. Three patients with episodic anterograde memory problems and depression had extensive limbic lesions and developed severe atrophy, mainly of the medial temporal lobes. The antibodies were identified in serum and CSF based on the typical staining pattern of AK5 antibodies on a tissue-based assay (here, unfixed mouse brain). Subsequently, they were confirmed by a research laboratory through a cell-based assay.
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Affiliation(s)
| | - Ferdinand Nehls
- Katholisches Krankenhaus Hagen, Department of Neurology, Hagen, Germany
| | - Rainer Kollmar
- Klinikum Darmstadt, Department of Neurology and Neurological Intensive Care, Darmstadt, Germany
| | - Maria Weis
- Klinikum Darmstadt, Department of Neurology and Neurological Intensive Care, Darmstadt, Germany
| | - Wolfgang Steinke
- Marien-Hospital Düsseldorf, Department of Neurology, Düsseldorf, Germany
| | - Friedrich Woermann
- Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany; Society of Epilepsy Research, Bielefeld, Germany
| | - Josep Dalmau
- Neurology Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barelona, Spain; ICREA (Catalan Institution for Research and Advanced Studies), Barcelona, Spain; Department of Neurology, University of Pennsylvania, Philadelphia, USA
| | - Christian G Bien
- Laboratory Krone, Bad Salzuflen, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany.
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