Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Experience of Meningovascular Syphilis in Human Immunodeficiency Virus Infected Patient

  • Lee, Jung-Pyo (Department of Neurosurgery, College of Medicine, Soonchunhyang University) ;
  • Koo, Sun-Ho (Department of Neurosurgery, College of Medicine, Soonchunhyang University) ;
  • Jin, So-Young (Department of Pathology, College of Medicine, Soonchunhyang University) ;
  • Kim, Tae-Hyong (Division of Infectious Disease, Department of Internal Medicine, College of Medicine, Soonchunhyang University)
  • Published : 2009.10.28
Download PDF
⟨ Previous Next ⟩

Abstract

Since the start of the antibiotic era, syphilis has become rare. However, in recent times, it has tended to be prevalent concomitantly with human immunodeficiency virus (HIV) infection and coinfection in North America and Europe. Now, such cases are expected to increase in elsewhere including Korea. A 40-year-old male patient visited hospital complaining of a headache for about one month. Brain computed tomography and magnetic resonance imaging, showed leptomeninged enhancing mass with edema an right porisylvian region, which was suspected to be glioma. Patient underwent a blood test and was diagnosed with syphilis and acquired immune deficiency syndrome. Partial cortical and subcortical resection were performed after small craniotomy. The dura was thick, adhered to the brain cortex, and was accompanied by hyperemic change of the cortex. The pathologic diagnosis was meningovascular syphilis (MS) in HIV infection. After the operation, the patient was treated with aqueous penicillin G. Thereafter, he had no neurological deficit except intermittent headache. At first, this case was suspected to be glioma, but it was eventually diagnosed as MS in HIV coinfection. At this point the case was judged to be worth reporting.

Keywords

References

  1. 1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention. MMWR Recomm Rep 47 : 1-111, 1998
  2. Blocker ME, Levine WC, St Louis ME : HIV prevalence in patients with syphilis, United States. Sex Transm Dis 27 : 53-59, 2000 https://doi.org/10.1097/00007435-200001000-00011
  3. Bord$\acute{o}$n J, Martínez-V$\acute{a}$zquez C, Alvarez M, Miralles C, Ocampo A, de la Fuente-Aguado J, et al. : Neurosyphilis in HIV-infected patients. Eur J Clin Microbiol Infect Dis 14 : 864-869, 1995 https://doi.org/10.1007/BF01691492
  4. Brandon WR, Boulos LM, Morse A : Determining the prevalence of neurosyphilis in a cohort co-infected with HIV. Int J STD AIDS 4 : 99-101, 1993
  5. Centers for Disease Control and Prevention (CDC) : Global Disease Elimination and Eradication as Public Health Strategies. Proceedings of a conference. Atlanta, Georgia, USA. 23-25 February 1998. MMWR Morb Mortal Wkly Rep 48 Suppl : 1-208, 1999
  6. Centers for Disease Control and Prevention (CDC) : Primary and secondary syphilis-United States, 1999. MMWR Morb Mortal Wkly Rep 50 : 113-117, 2001
  7. Dowell ME, Ross PG, Musher DM, Cate TR, Baughn RE : Response of latent syphilis or neurosyphilis to ceftriaxone therapy in persons infected with human immunodeficiency virus. Am J Med 93 : 481-488, 1992 https://doi.org/10.1016/0002-9343(92)90574-U
  8. Genest DR, Choi-Hong SR, Tate JE, Qureshi F, Jacques SM, Crum C : Diagnosis of congenital syphilis from placental examination : comparison of histopathology, Steiner stain, and polymerase chain reaction for Treponema pallidum DNA. Hum Pathol 27 : 366-372, 1996 https://doi.org/10.1016/S0046-8177(96)90110-0
  9. Gordon SM, Eaton ME, George R, Larsen S, Lukehart SA, Kuypers J, et al. : The response of symptomatic neurosyphilis to high-dose intravenous penicillin G in patients with human immunodeficiency virus infection. N Engl J Med 331 : 1469-1473, 1994 https://doi.org/10.1056/NEJM199412013312201
  10. Greenblatt RM, Lukehart SA, Plummer FA, Quinn TC, Critchlow CW, Ashley RL, et al. : Genital ulceration as a risk factor for human immunodeficiency virus infection. AIDS 2 : 47-50, 1988 https://doi.org/10.1097/00002030-198802000-00008
  11. Hart G : Syphilis tests in diagnostic and therapeutic decision making. Ann Intern Med 104 : 368-376, 1986 https://doi.org/10.7326/0003-4819-104-3-368
  12. Holtom PD, Larsen RA, Leal ME, Leedom JM : Prevalence of neurosyphilis in human immunodeficiency virus-infected patients with latent syphilis. Am J Med 93 : 9-12, 1992 https://doi.org/10.1016/0002-9343(92)90673-Y
  13. Johns DR, Tierney M, Felsenstein D : Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 316 : 1569-1572, 1987 https://doi.org/10.1056/NEJM198706183162503
  14. Jones HD, Urquhart N, Mathias RG, Banerjee SN : An evaluation of oligoclonal banding and CSF IgG index in the diagnosis of neurosyphilis. Sex Transm Dis 17 : 75-79, 1990 https://doi.org/10.1097/00007435-199004000-00006
  15. Katz DA, Berger JR, Duncan RC : Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus. Arch Neurol 50 : 243-249, 1993 https://doi.org/10.1001/archneur.1993.00540030009006
  16. Lukehart SA, Hook EW 3rd, Baker-Zander SA, Collier AC, Critchlow CW, Handsfield HH : Invasion of the central nervous system by Treponema pallidum : implications for diagnosis and treatment. Ann Intern Med 109 : 855-862, 1988 https://doi.org/10.7326/0003-4819-109-11-855
  17. MacLean S, Luger A : Finding neurosyphilis without the Venereal Disease Research Laboratory test. Sex Transm Dis 23 : 392-394, 1996 https://doi.org/10.1097/00007435-199609000-00008
  18. Marra CM, Boutin P, McArthur JC, Hurwitz S, Simpson PA, Haslett JA, et al. : A pilot study evaluating ceftriaxone and penicillin G as treatment agents for neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis 30 : 540-544, 2000 https://doi.org/10.1086/313725
  19. Marra CM, Critchlow CW, Hook EW 3rd, Collier AC, Lukehart SA : Cerebrospinal fluid treponemal antibodies in untreated early syphilis. Arch Neurol 52 : 68-72, 1995 https://doi.org/10.1001/archneur.1995.00540250072015
  20. Tomberlin MG, Holtom PD, Owens JL, Larsen RA : Evaluation of neurosyphilis in human immunodeficiency virus-infected individuals. Clin Infect Dis 18 : 288-294, 1994 https://doi.org/10.1093/clinids/18.3.288
  21. van Voorst Vader PC : Syphilis management and treatment. Dermatol Clin 16 : 699-711, xi, 1998 https://doi.org/10.1016/S0738-081X(98)00071-6
  22. Wolters EC, Hische EA, Tutuarima JA, van Trotsenburg L, van Eijk RV, Bos JD, et al. : Central nervous system involvement in early and late syphilis : the problem of asymptomatic neurosyphilis. J Neurol Sci 88 : 229-239, 1988 https://doi.org/10.1016/0022-510X(88)90220-1

Cited by

  1. A Case of Neurosyphilis with Acute Optic Neuritis and Trochlear Nerve Palsy in Human Immunodeficiency Virus Infected Male vol.42, pp.4, 2009, https://doi.org/10.3947/ic.2010.42.4.262
  2. Cerebral Syphilitic Gumma Mimicking a Brain Tumor in the Relapse of Secondary Syphilis in a Human Immunodeficiency Virus-Negative Patient vol.53, pp.3, 2009, https://doi.org/10.3340/jkns.2013.53.3.197
  3. Neurosyphilis presenting as acute ischemic stroke vol.20, pp.1, 2009, https://doi.org/10.7861/clinmed.2019-0368
  4. Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review vol.35, pp.33, 2009, https://doi.org/10.3346/jkms.2020.35.e271