1
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Carranza O, Waheed S, Yousuf F. The Great Masquerader: Recurrent Ischemic Strokes Secondary to Meningovascular Syphilis in a Man With Cardiovascular Stroke Risk Factors. Cureus 2024; 16:e56330. [PMID: 38628993 PMCID: PMC11021037 DOI: 10.7759/cureus.56330] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
A male in his 60s with stroke risk factors presented with confusion and word-finding difficulties. He was diagnosed with acute ischemic stroke in the right basal ganglia. He was started on secondary stroke prevention measures including dual antiplatelet therapy and a high-dose statin. A highly reactive rapid plasma reagin (RPR) was performed as part of the workup and found to be positive. Follow-up fluorescent treponemal antibody absorption (TPA) test was also positive, confirming a diagnosis of syphilis. He was discharged home with a scheduled course of antibiotic treatment for tertiary syphilis but returned due to a new episode of transient facial paralysis. Further workup and physical exam findings revealed the patient had neurosyphilis. He was started on the appropriate antibiotic therapy, which significantly improved his confusion and prevented new episodes of stroke.
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Affiliation(s)
- Octavio Carranza
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Sadia Waheed
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Fawad Yousuf
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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2
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Malyshev M, Safuanov A, Malyshev A, Rostovykh A, Sinyukov D, Rostovykh N, Trushina V. Surgery for Ascending Aortic Aneurysm and Aortic Valve Insufficiency in Conditions of Active Proceeding Syphilitic Aortitis and Valvulitis. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 36967122 PMCID: PMC10902664 DOI: 10.5761/atcs.cr.22-00236] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
A syphilitic aortitis is a late cardiovascular lesion of tertiary syphilis that has become exceptionally rare in the antibiotic era but not eradicated completely. Syphilitic aortitis of ascending aorta complicates in ascending aortic aneurysm formation and aortic valve regurgitation, both requiring surgical treatment. After surgery, lifelong surveillance of the remainder of the aorta is recommended because of a priori supposed high incidence of delayed involvement of noninvolved aortic segments. A 3-year follow-up result of surgery of syphilitic ascending aortic aneurysm with aortic valve regurgitation in condition of active ongoing syphilitic aortitis and valvulitis is described with addressing the dimensions of remaining aortic segments. This case demonstrates that the dilatation of the remainder of the aorta does not occur during 3 years, at least when anti-syphilitic course of antibiotic is used just after operation without additional treatment during the follow-up period. A few reports on surgical treatment of syphilitic aneurysms of the ascending aorta are discussed.
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Affiliation(s)
| | | | - Anton Malyshev
- Center of Cardiac Surgery, Chelyabinsk, Russian Federation
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3
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Kaur B, Khanna D. A Narrative Review of the Many Psychiatric Manifestations of Neurosyphilis: The Great Imitator. Cureus 2023; 15:e44866. [PMID: 37814742 PMCID: PMC10560128 DOI: 10.7759/cureus.44866] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Neurosyphilis is an infection of the central nervous system caused by the spirochete, Treponema pallidum. New syphilis infections have been increasing around the world each year. This disease was much of a concern in the pre-penicillin era, where when left untreated many cases progressed to tertiary syphilis which can commonly manifest as neurosyphilis. Of particular interest, neurosyphilis has been linked to masquerading itself as various psychiatric conditions. This narrative review focuses on exploring psychiatric manifestations of neurosyphilis as well as the importance of screening in psychiatric settings and clinicians maintaining high clinical suspicion of the disease. A systematic search was conducted for published articles from 2003 to 2023 using PubMed, EMBASE, and Google Scholar. A total of 66 articles met the criteria and were used for detailed analysis, where psychiatric manifestations and clinical progression of patients were discussed in detail. Psychiatric manifestations that were explored include dementia, delirium, depression, mania, personality changes, and psychosis. One of the most common manifestations of neurosyphilis appears to be severe neurocognitive impairment. There are also rare psychiatric conditions neurosyphilis mimics that have been described in literature such as Capgras syndrome and Geschwind syndrome. A narrative review of the literature revealed a low level of clinical awareness of neurosyphilis as a possible etiology of various psychiatric disorders. This resulted in delayed or inaccurate diagnosis and consequently delayed initiation of adequate treatment. Considering that many psychiatric manifestations of neurosyphilis are reversible with proper treatment, it is imperative to implement routine screening for syphilis among psychiatric patients.
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Affiliation(s)
- Baneet Kaur
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College Of Osteopathic Medicine, Clearwater, USA
| | - Deepesh Khanna
- Department of Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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4
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Yazigi A, Yazigi M, Zainah H. A Rare Case of Neurosyphilis Manifesting as Psychosis in an HIV-Negative Patient. Cureus 2023; 15:e40064. [PMID: 37425525 PMCID: PMC10325951 DOI: 10.7759/cureus.40064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Neurosyphilis is a rare disease now, given the availability of antibiotics to treat syphilis. Patients with neurosyphilis could present with psychiatric symptoms. We present a rare case of neurosyphilis with only psychiatric symptoms. The patient was a 49-year-old male who presented with self-neglect and was not interacting with others. Treponema antibodies were positive, and rapid plasma reagin (RPR) was 1:512 with a positive venereal disease research laboratory test (VDRL) in the cerebrospinal fluid. The patient was treated with an IV penicillin regimen for neurosyphilis and improved remarkably with a return to baseline on follow-up.
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Affiliation(s)
- Angela Yazigi
- Infectious Diseases, Al-Baath University, Faculty of Medicine, Homs, SYR
| | - Majed Yazigi
- Infectious Diseases, Al-Baath University, Faculty of Medicine, Homs, SYR
| | - Hadeel Zainah
- Infectious Diseases, Kent-County Memorial Hospital, Warwick, USA
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5
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Katayama K, Ishizuka K, Tawara J, Kaji Y, Komuta M, Hayashi Y, Gomi H, Akahane M, Ohira Y. Temporal Arteritis Caused by Tertiary Syphilis. Intern Med 2023; 62:1095-1097. [PMID: 36047113 PMCID: PMC10125830 DOI: 10.2169/internalmedicine.9779-22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man arrived at our hospital with bilateral shoulder pain persisting for several months and headache for 1 month. Giant cell arteritis with polymyalgia rheumatica was suspected. However, considering his medical history of testing positive for syphilis, we submitted a sample for a syphilis serology test, which yielded positive results. The Treponema pallidum hemagglutination assay of cerebrospinal fluid was positive, and a temporal artery biopsy revealed vasculitis, confirming the diagnosis of tertiary syphilis. He was successfully treated for two weeks with penicillin G infusions. Symptoms reminiscent of giant cell arteritis and polymyalgia rheumatica may reveal syphilis, which is called the "great imitator."
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Affiliation(s)
- Kohta Katayama
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Junsuke Tawara
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Yuki Kaji
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Mina Komuta
- Department of Pathology, International University of Health and Welfare, Japan
| | - Yuichiro Hayashi
- Department of Pathology, International University of Health and Welfare, Japan
| | - Harumi Gomi
- Office of Medical Education and Center for Infectious Diseases, International University of Health and Welfare, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
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6
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Angerer M, Lübbersmeyer F, Gübitz R, Wülfing C, Dieckmann KP. Tertiary Syphilitic Gumma Mimicking Testicular Neoplasms. Cureus 2023; 15:e37392. [PMID: 37051441 PMCID: PMC10085538 DOI: 10.7759/cureus.37392] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/14/2023] Open
Abstract
Palpable testicular masses in men aged 20 to 50 years usually represent testicular germ cell tumors. Diagnostic work-up involves ultrasound examination as well as serum tumor markers alpha fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, and particularly the novel marker M371. Orchidectomy is mandatory for germ cell tumors. We report the rare case of testicular involvement by tertiary syphilis mimicking testicular neoplasms with testis-sparing management. A 46-year-old Caucasian male presented with a painless firm mass in the right testicle and multiple cutaneous plaques at the skin of the scrotum, penis and right forearm. Testicular serum tumor markers were negative. Syphilis Rapid Plasma Reagin test and Treponema pallidum immunoglobulin antibodies tests were positive. Radiological examination revealed bilateral testicular lesions as well as bipulmonal pleural-based opacities. Conservative management was attempted and treatment with ceftriaxone (2 g/day) intravenously for 14 days was administered. The testicular findings improved rapidly and significantly during antibiotic treatment. Radiological follow-up examinations after two weeks and two months showed further regression of the testicular and pulmonary lesions. This case represents an extremely rare testicular manifestation of tertiary syphilis. Due to rising syphilis incidence in Europe, tertiary syphilis with formation of gumma should be a differential diagnosis of testicular tumor. Thus, syphilis-specific treatment is safe and orchidectomy can be avoided.
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Affiliation(s)
- Markus Angerer
- Department of Urology, Asklepios Klinik Altona, Hamburg, DEU
| | | | - Raphael Gübitz
- Department of Radiology, Asklepios Klinik Altona, Hamburg, DEU
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7
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Jankowska L, Adamski Z, Polańska A, Bowszyc-Dmochowska M, Plagens-Rotman K, Merks P, Czarnecka-Operacz M, Żaba R. Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review. Int J Environ Res Public Health 2022; 19:16992. [PMID: 36554872 PMCID: PMC9778711 DOI: 10.3390/ijerph192416992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Tertiary syphilis is a large diagnostic challenge. It is rarely the case that it affects the skin, bone tissue and the eyes at the same time. The presented case shows that extensive symptomatology of syphilis poses a challenge in making a proper diagnosis in patients whose history does not suspect STDs. The study aims to present the case of a young woman hospitalized with a suspected autoimmune disease, diagnosed with symptomatic late syphilis with involvement of the skin, bones and eyes.
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Affiliation(s)
- Lucyna Jankowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Katarzyna Plagens-Rotman
- Center for Pediatric, Adolescent Gynecology and Sexology Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
| | - Magdalena Czarnecka-Operacz
- Allergic and Occupational Skin Diseases Unit, Department of Dermatology, Medical University of Poznań, 60-355 Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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8
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Skiepko U, Serwin AB, Piłasewicz-Puza A, Flisiak I. Nodulo-ulcerative syphilis - case report and the review of literature. Przegl Epidemiol 2022; 76:184-189. [PMID: 36217907 DOI: 10.32394/pe.76.18] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We describe the case of tertiary syphilis involving the skin. The lesions had a nodular-ulcerative form, localized on both arms. The patient had high titers of treponemal and non-treponemal serological tests for syphilis and histopathological picture was indicative for nodulo-ulcerative syphilis. No cardiological, neurological or ophtalmological abnormalities were found. The patient was treated with 2.4 million units i.m. of benzathine benzylpenicillin three times at weekly intervals, according to European Guideline. Unfortunately, the patient was lost for scheduled follow-up. More than two years later the skin lesions healed completely leaving discrete scars and a four-fold decline in a titre of Venereal Disease Laboratory Test was noticed.
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Affiliation(s)
- Urszula Skiepko
- Department of Dermatology and Venerology, Medical University of Białystok, Poland
| | | | | | - Iwona Flisiak
- Department of Dermatology and Venerology, Medical University of Białystok, Poland
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9
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Ao X, Chen JH, Kata P, Kanukuntla A, Bommu V, Rothberg M, Cheriyath P. The Great Impostor Did It Again: Syphilitic Arthritis. Cureus 2021; 13:e17344. [PMID: 34567885 PMCID: PMC8451258 DOI: 10.7759/cureus.17344] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/05/2022] Open
Abstract
Syphilis-related bone and joint involvement is commonly found in congenital form, but it can also be seen in adults with acquired syphilis as a rare sequela of infectious syphilis. We report a case of syphilitic arthritis where the patient presented with multiple problems over the course of several visits and was eventually diagnosed with tertiary syphilis as the source of his musculoskeletal complaints. The clinical manifestations of syphilis can be diverse and challenging, as evidenced by our case. Unusual clinical manifestations might be seen in syphilis, and clinicians may not be familiar with these clinical presentations while diagnosing. Being aware of arthropathy in syphilis and including it in the differential diagnoses will help improve patient outcomes and avoid unfavorable consequences, particularly in the high-risk group.
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Affiliation(s)
- Xue Ao
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Jia Hong Chen
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Priyaranjan Kata
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Anish Kanukuntla
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Veera Bommu
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Michael Rothberg
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Pramil Cheriyath
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
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10
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Cocora M, Nechifor D, Lazar MA, Mornos A. Impending Aortic Rupture in a Patient with Syphilitic Aortitis. Vasc Health Risk Manag 2021; 17:255-258. [PMID: 34079272 PMCID: PMC8164716 DOI: 10.2147/vhrm.s289455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/03/2021] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 48-year-old man, admitted for atrial fibrillation with rapid heart rate and intense chest pain. A quick evaluation revealed a giant aortic aneurysm with severe aortic regurgitation and pericardial fluid without a trace of aortic dissection. Because of high suspicion of aortic rupture, an emergency surgery was planned, and a Bentall procedure was performed. On examination of the aortic wall revealing vertical wrinkling with a tree bark aspect, suspicion of syphilitic aortitis arose. The diagnosis was confirmed through postoperative serologic testing and histological examination. Histopathologic differential diagnosis, special treatment and follow-up are presented.
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Affiliation(s)
- Mioara Cocora
- Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Dan Nechifor
- Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Mihai-Andrei Lazar
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Aniko Mornos
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
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11
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Li X, Zhong Y, Rao L, Bai W. A dissecting aneurysm of the sinus of Valsalva involving the inter-ventricsular septum in a patient with syphilis and a quadricuspid aortic valve. Echocardiography 2021; 38:1061-1063. [PMID: 33929064 DOI: 10.1111/echo.15055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/05/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 02/05/2023] Open
Abstract
Aneurysms of the sinus of Valsalva are rare, with dissecting aneurysms of the sinus of Valsalva that extend into the inter-ventricular septum being even more rare. This report describes a young patient with syphilis and a quadricuspid aortic valve who experienced a spontaneously dissecting aneurysm of the sinus of Valsalva and the basal inter-ventricular septum.
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Affiliation(s)
- Xiang Li
- Cardiology Department, West China Hospital, Sichuan University, China
| | - Yue Zhong
- Cardiology Department, West China Hospital, Sichuan University, China
| | - Li Rao
- Cardiology Department, West China Hospital, Sichuan University, China
| | - Wenjuan Bai
- Cardiology Department, West China Hospital, Sichuan University, China
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12
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Pumnea T, Fiocco Z, Clanner-Engelshofen BM, Flaig M, French LE, Reinholz M. Non-itchy, Nodular Intermittently Healing Persistent Lesions on the Neck, Arms and Gluteus: A Quiz. Acta Derm Venereol 2021; 101:adv00432. [PMID: 33723617 PMCID: PMC9364255 DOI: 10.2340/00015555-3786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Teodora Pumnea
- Department of Dermatology and Allergy, University Hospital of Munich (LMU), DE-80337 Munich, Germany
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13
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Paviolo JP, Imbach MC, Nocenti ZA, Durand BL. [Rapidly progressive dementia due to neurosyphilis (general paralysis). A treatable case of dementia]. Medicina (B Aires) 2020; 80:401-404. [PMID: 32841147] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
Rapidly progressive dementias are conditions of impairment in more than one cognitive domain with functional compromise that progress in less than 1 to 2 years; and neurosyphilis is one of the etiologies. Syphilis is a chronic bacterial infection that causes a series of highly variable clinical conditions during the first 2 to 3 years, followed by a prolonged latent stage that can progress to a tertiary infection stage. After a period of years, or even decades, a third of people with untreated latent syphilis will have clinical manifestations of tertiary syphilis such as neurosyphilis. We present the case of a 41-year-old man who consulted for prostration symptoms, preceded by progressive behavioral cognitive alterations of 18 months of evolution. A dementia picture was found associated with pharmacological parkinsonism secondary to risperidone, so this treatment was suspended. Neuroimaging showed severe cerebral atrophy; serum and cerebrospinal fluid (CSF) reactive VDRL, in addition to a slight increase in CSF proteins. The diagnosis of late neurosyphilis was made and treated with crystalline penicillin G 1 400 000 IU every 4 h for 14 days with an excellent response. Our case allows us to reflect on the importance of requesting diagnostic studies of syphilis in young patients who present a rapidly evolving dementia, since this disease has a treatment that can partially or totally reverse the symptoms.
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Affiliation(s)
- Juan Pablo Paviolo
- Servicio de Neurología, Hospital SAMIC, Eldorado, Misiones, Argentina. E-mail:
| | | | - Zulma A Nocenti
- Servicio de Infectología, Hospital SAMIC, Eldorado, Misiones, Argentina
| | - Bruno L Durand
- Servicio de Clínica Médica, Hospital SAMIC, Eldorado, Misiones, Argentina
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14
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Abstract
OBJECTIVES To review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era. METHODS A retrospective review of all neurosyphilis and tertiary syphilis cases reported in Alberta from 1973 to March 2017 was undertaken and cases classified into early neurosyphilis, late neurosyphilis and cardiovascular (CV) syphilis. Variables collected included demographics, sexual partners, HIV status, clinical parameters, symptoms and treatment and distributions were compared between early versus late neurosyphilis and asymptomatic versus symptomatic cases (stratified by early versus late stage). Data were analysed using IBM SPSS Statistics V.19.0. RESULTS 254 cases were identified; 251 were neurosyphilis and 3 were CV. No cases of gummatous syphilis were reported. Early neurosyphilis accounted for 52.4% (n=133) and 46.1% (n=117) were late neurosyphilis cases; one (0.4%) case with unknown duration. Three outbreaks of infectious syphilis were identified during the study period and a concurrent rise in both early and late neurosyphilis was observed during the outbreak periods. The most common manifestation of symptomatic neurosyphilis was ocular involvement which was more likely in early neurosyphilis. Relative to late neurosyphilis cases, early neurosyphilis cases were more likely to be younger, Caucasian, born in Canada, HIV positive and reporting same sex partners. CONCLUSIONS Our review of tertiary and neurosyphilis cases found that early and late neurosyphilis cases continue to occur in the context of cycling syphilis outbreaks. CV syphilis cases were extremely rare. Ongoing identification of new cases of syphilis and clinical evaluation of cases for complications continues to be important in the context of global resurgence of syphilis.
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Affiliation(s)
- Takaaki Landry
- Immunology and Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Petra Smyczek
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Ryan Cooper
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Ron Read
- Alberta Health Services, Calgary, Alberta, Canada
| | - Barbara Romanowski
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Ameeta E Singh
- Department of Medicine/Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
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15
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Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Gurkovskaya EP, Alferova AA, Alferova MA, Beresneva TA. [Clinical manifestations of syphilis in maxillofacial area. Part II]. Stomatologiia (Mosk) 2019; 97:62-64. [PMID: 29992943 DOI: 10.17116/stomat201897362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents a review of the literature with a description of typical manifestations in the maxillofacial area in secondary, tertiary period of syphilis and the description of photo-images of the authors' clinical observations. In the secondary period of syphilis rashes can be found both on the skin and mucous membranes. In secondary reccurent syphilis the oral cavity is affected in 56% of the cases. Typical manifestations of this period are: roseola, papular and pustular syphilides. In the mouth the most frequently observed manifestation is popular syphilide or erythematous sore throat. The syphilitic papule of the mucous membrane of the mouth is flat, sharply demarcated, gets frequently eroded due to maceration or trauma. This papule is highly contagious element. Pustular syphilides are found mostly on the face and are a manifestation of a malignant course of the disease. Tertiary syphilis is a rare form of infection, which is observed as destructive injuries of organs and systems. The most frequent localization of gummy syphilide is the head. This article is highly revalent due to the high frequency of infection manifestation in maxillo-facial area, oral mucosa, and the high contagiousness symptoms, also affecting children.
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Affiliation(s)
- M A Ufimtseva
- Ural State Medical University, Russia, 620028, Ekaterinburg, str. Repina, 3
| | - I F Vishnevskaya
- Ural State Medical University, Russia, 620028, Ekaterinburg, str. Repina, 3
| | - Yu M Bochkarev
- Ural State Medical University, Russia, 620028, Ekaterinburg, str. Repina, 3
| | - E P Gurkovskaya
- Ural State Medical University, Russia, 620028, Ekaterinburg, str. Repina, 3
| | - A A Alferova
- Ural State Medical University, Russia, 620028, Ekaterinburg, str. Repina, 3
| | - M A Alferova
- Scientific and Practical Center 'Bonum', Russia, 620149, Ekaterinburg, str. Academica Bardina, 9a
| | - T A Beresneva
- Ural State Medical University, Russia, 620028, Ekaterinburg, str. Repina, 3
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Solis RN, Kuhn BT, Farwell DG. An Unusual Case of Tertiary Syphilis Behaving Like Tongue Squamous Cell Carcinoma. J Investig Med High Impact Case Rep 2018; 6:2324709618820355. [PMID: 30622992 PMCID: PMC6302270 DOI: 10.1177/2324709618820355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 12/28/2022] Open
Abstract
Syphilis may present with a myriad of oral manifestations in the primary, secondary, and tertiary stages, and may be confused with malignancy. Despite a rise in the incidence of syphilis, tertiary syphilis is exceedingly rare. Tertiary syphilis gummas usually affect the hard palate, while tongue involvement is very rare. A 55-year-old male with extensive smoking and alcohol use was referred for malignancy evaluation with an ulcerative mass creating a tongue cleft, and a positron emission tomography scan suggestive for malignancy. Biopsy results demonstrated no carcinoma but histology demonstrated granulomatous inflammation. Further laboratory results demonstrated elevated rapid plasma reagin titers with Treponema pallidum immunoglobulin G antibodies present. The patient was diagnosed with tertiary syphilis, received appropriate antibiotic therapy, and had healing of the tongue with a persistent cleft. Syphilis may mimic many disease processes. As such, it is important to include this disease in the differential of an unusual tongue lesion. An oral lesion may be the first sign of infection.
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Affiliation(s)
- Roberto N Solis
- Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Brooks T Kuhn
- Division of Pulmonary Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - D Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, CA, USA
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Charlton OA, Puri P, Davey L, Weatherall C, Konecny P. Rapid progression to gummatous tertiary syphilis in a patient with HIV. Australas J Dermatol 2018; 60:e48-e50. [PMID: 29882582 DOI: 10.1111/ajd.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/28/2018] [Accepted: 04/14/2018] [Indexed: 10/14/2022]
Abstract
Co-infection with human immunodeficiency virus-1 (HIV) and syphilis is associated with rapid progression to tertiary syphilis. This case report describes the early development of gummatous skin disease and suspected neurosyphilis in a patient with untreated HIV and approaches to treatment.
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Affiliation(s)
- Olivia A Charlton
- Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Prianka Puri
- Department of Renal Medicine, Canberra Hospital, Canberra, Capital Territory, Australia
| | - Louella Davey
- Department of Anatomical Pathology, St George Hospital, Sydney, New South Wales, Australia
| | - Chris Weatherall
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, New South Wales, Australia.,St George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Pamela Konecny
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, New South Wales, Australia.,St George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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18
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de Araujo DB, Oliveira DS, Rovere RK, de Oliveira Filho UL. Aortic aneurysm in a patient with syphilis-related spinal pain and paraplegia. Reumatologia 2017; 55:151-3. [PMID: 28769140 DOI: 10.5114/reum.2017.68916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/28/2017] [Indexed: 02/04/2023] Open
Abstract
The tertiary stage of syphilis is nowadays extremely rare, showing predilection for the cardiovascular and nervous systems. A 57-year-old Caucasian man sought medical assistance due to back pain that evolved to paraplegia of the lower limbs. A thoracic CT scan demonstrated an important aneurysmatic lesion of the descending thoracic aorta causing erosion of the vertebral bodies and VDRL and FTA-abs positivity. Although rare, syphilitic aortitis, the hallmark of cardiovascular syphilis, should be considered in the differential diagnosis in patients with thoracic aneurysm when in the absence of classic risk factors for atherosclerosis, especially in cases that progress with erosion of vertebral bodies.
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Abstract
Syphilis, the "great imitator," with regard to skin diseases, is a chronic systemic infectious disease with a clinical course that waxes and wanes. The incidence of tertiary syphilis had decreased drastically these decades. We report a case of tertiary neurosyphilis presenting with moth-eaten bone lesions of the lower extremities. To the best of our knowledge, we have not seen such reports.
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Affiliation(s)
- Xue-Gang Xu
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, China; Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China
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Affiliation(s)
- Karima Chakir
- Service de Dermatologie et vénérologie CHU Ibn Rochd Casablanca, Maroc
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21
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Salem KMI, Majeed H, Bommireddy R, Klezl Z. Tertiary syphilis in the cervical spine: a case report and review of the literature. Global Spine J 2013; 3:41-6. [PMID: 24436850 PMCID: PMC3854603 DOI: 10.1055/s-0032-1329887] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/07/2012] [Indexed: 10/27/2022] Open
Abstract
As the prevalence of syphilis rises, an increase in tertiary syphilis with spinal involvement is predicted. We report what we believe to be the first case of compressive cervical spine syphilitic gummata, with central cord compression signs. We also review the relevant literature to date. The diagnosis of syphilis in the spine relies on the physician to be aware of it as part of the differential diagnosis. Treponemal laboratory tests are an important aid in establishing a diagnosis.
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Affiliation(s)
- K. M. I. Salem
- The Department of Trauma and Orthopaedic Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - H. Majeed
- The Department of Trauma and Orthopaedic Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - R. Bommireddy
- The Department of Trauma and Orthopaedic Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Z. Klezl
- The Department of Trauma and Orthopaedic Surgery, Royal Derby Hospital, Derby, United Kingdom,Orthopedic Department of Third Medical School, Charles University, Prague, Czech Republic,Address for correspondence Mr. Z. Klezl, M.D., Ph.D. The Department of Trauma and Orthopaedic SurgeryRoyal Derby Hospital, Uttoxeter Road, Derby DE22 3NEUnited Kingdom
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Yaméogo AA, Andonaba JB, Nikiéma Z, Zabsonré P. [Syphilitic aortic insufficiency: report of a case]. Pan Afr Med J 2012; 12:69. [PMID: 23024828 PMCID: PMC3450931] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/04/2012] [Indexed: 11/12/2022] Open
Abstract
La syphilis tertiaire et ses complications cardiovasculaires sont devenues rares dans les pays développés mais restent encore préoccupante dans nos pays. Les atteintes cardiovasculaires portent fréquemment sur la racine et l’arche aortique. Nous rapportons ici un cas d’insuffisance aortique syphilitique chez un patient de 70 ans admis dans le service de cardiologie du centre hospitalier universitaire de Bobo-Dioulasso. L’examen clinique retrouvait une insuffisance cardiaque globale stade III, un frémissement et un souffle diastolique d’insuffisance aortique importante confirmé à l’échocardiographie Doppler, associés à des douleurs précordiales angineuses. L’examen cutané montrait des lésions à type de gommes syphilitiques à localisations multiples. L’électrocardiogramme objectivait une hypertrophie ventriculaire gauche avec un indice de Sokolov à 49 millimètre et le télécoeur une cardiomégalie avec un index cardio-thoracique à 0,70. La sérologie était positive pour le RPR à 1/8 et le TPHA à 1/640. L’évolution clinique sous la pénicillino-thérapie surveillée et le traitement spécifique de l’insuffisance cardiaque a été favorable. La découverte d’une insuffisance aortique chez les sujets de plus de 60 ans dans nos pays devrait faire rechercher une syphilis tertiaire par une sérologie pour une prise en charge adéquate.
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Affiliation(s)
- Aimé Arsène Yaméogo
- Institut Supérieur des Sciences de la Santé/Université Polytechnique de Bobo-Dioulasso, Burkina Faso,Service de Cardiologie, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso,Corresponding author: Dr Yaméogo Aimé Arsène: Médecin cardiologue, Assistant en Cardiologie à l’Institut Supérieur des Sciences de la Santé/ Université Polytechnique de Bobo-Dioulasso. Service de Cardiologie du Centre Hospitalier Universitaire Souro Sanou (CHUSS). Adresse: 03 BP: 4086 Bobo-Dioulasso 03, Burkina Faso
| | - Jean-Baptiste Andonaba
- Institut Supérieur des Sciences de la Santé/Université Polytechnique de Bobo-Dioulasso, Burkina Faso
| | - Zakari Nikiéma
- Institut Supérieur des Sciences de la Santé/Université Polytechnique de Bobo-Dioulasso, Burkina Faso
| | - Patrice Zabsonré
- Unite de Formation et de Recherche-Science De la Santé (UFR-SDS), Université de Ouagadougou, Burkina Faso,Service de cardiologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
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Housman B, Bellary SS, Walters A, Mirzayan N, Tubbs RS, Loukas M. Moritz Heinrich Romberg (1795-1873): Early founder of neurology. Clin Anat 2012; 27:147-9. [PMID: 22711686 DOI: 10.1002/ca.22112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/23/2012] [Revised: 04/04/2012] [Accepted: 05/14/2012] [Indexed: 11/07/2022]
Abstract
Moritz Heinrich Romberg (1795-1873) began his pursuit of neurology in 1820 by translating into German Andrew Marshall's The Morbid Anatomy of the Brain. In 1830, Romberg was hired as Privatdozent of special pathology and therapy in the Charité, the University Hospital of Berlin. He quickly rose to director of the royal clinic in 1845, at which time he wrote Lehrbuch der Nervenkrankheiten des Menschen, a text generally regarded as the first formal treatise on nervous diseases. He identified the role of proprioception in tabes dorsalis, and became the first neurologist to describe the typical pupillary presentation found in patients with tertiary syphilis. Romberg is perhaps most famous for identifying "Romberg's sign," the distinctive sensory ataxia observed in neuropathies of the dorsal columns.
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Affiliation(s)
- Brian Housman
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
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