Neurosyphilis presenting as new onset refractory status epilepticus: one of the multifarious faces of a great imitator
Rafael Ruiz-Gaviria A * , Lilia Gutierrez Villarin A , Robert Ross A B and Crystal Janani CA Department of Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, USA.
B Infectious Diseases Associates P.A., Ellicot City, MD, USA.
C Department of Neurology, Ascension Saint Agnes Hospital, Baltimore, MD, USA.
Sexual Health 19(2) 141-144 https://doi.org/10.1071/SH21190
Submitted: 19 October 2021 Accepted: 10 March 2022 Published: 28 April 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Neurosyphilis can present in a myriad of ways, making the suspicion and diagnosis of this disease a great challenge for the clinician.
Methods: We present a case of a 54-year-old patient who initially presented with cognitive changes and was eventually found to have new onset refractory status epilepticus.
Results: Neurosyphilis is still a frequent entity nowadays, with involvement of both HIV positive and negative patients.
Conclusion: The presentation with new onset status epilepticus is rare and uncommon for neurosyphilis; however, its early identification and treatment could prevent further morbidity and mortality.
Keywords: immunocompetent, neurosyphilis, new onset refractory status epilepticus, status epilepticus, CSF, sexually transmitted disease, secondary seizure, VDRL.
References
[1] Ghanem KG, Ram S, Rice PA. The modern epidemic of Syphilis. N Engl J Med 2020; 382 845–54.| The modern epidemic of Syphilis.Crossref | GoogleScholarGoogle Scholar | 32101666PubMed |
[2] Schmidt R, Carson PJ, Jansen RJ. Resurgence of Syphilis in the United States: an assessment of contributing factors. Infect Dis Res Treat 2019; 12 1178633719883282
| Resurgence of Syphilis in the United States: an assessment of contributing factors.Crossref | GoogleScholarGoogle Scholar |
[3] Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, et al. Neurosyphilis in the modern era: literature review and case series. J Clin Neurosci 2019; 69 67–73.
| Neurosyphilis in the modern era: literature review and case series.Crossref | GoogleScholarGoogle Scholar | 31427238PubMed |
[4] Tuddenham S, Ghanem KG. Neurosyphilis: knowledge gaps and controversies. Sex Transm Dis 2018; 45 147–51.
| Neurosyphilis: knowledge gaps and controversies.Crossref | GoogleScholarGoogle Scholar | 29420441PubMed |
[5] Ropper AH. Neurosyphilis. N Engl J Med 2019; 381 1358–63.
| Neurosyphilis.Crossref | GoogleScholarGoogle Scholar | 31577877PubMed |
[6] Singh SM, Sharma R, Batra N, Sethi S. Neurosyphilis: an underdiagnosed entity. Asian J Psychiatry 2017; 30 47–8.
| Neurosyphilis: an underdiagnosed entity.Crossref | GoogleScholarGoogle Scholar |
[7] Gürses C, Bilgiç B, Topçular B, Tuncer OG, Akman-Demir G, Hanağasi H, et al. Clinical and magnetic resonance imaging findings of HIV-negative patients with neurosyphilis. J Neurol 2007; 254 368–74.
| Clinical and magnetic resonance imaging findings of HIV-negative patients with neurosyphilis.Crossref | GoogleScholarGoogle Scholar | 17345038PubMed |
[8] Drago F, Merlo G, Ciccarese G, Agnoletti AF, Cozzani E, Rebora A, et al. Changes in neurosyphilis presentation: a survey on 286 patients. J Eur Acad Dermatol Venereol JEADV 2016; 30 1886–900.
| Changes in neurosyphilis presentation: a survey on 286 patients.Crossref | GoogleScholarGoogle Scholar | 27306850PubMed |
[9] Kumari S, Hayton T, Jumaa P, McCorry D. ‘The great imitator’: neurosyphilis and new-onset refractory status epilepticus (NORSE) syndrome. Epilepsy Behav Case Rep 2015; 3 33–5.
| ‘The great imitator’: neurosyphilis and new-onset refractory status epilepticus (NORSE) syndrome.Crossref | GoogleScholarGoogle Scholar | 25859427PubMed |
[10] Gürses C, Kürtüncü M, Jirsch J, Yeşilot N, Hanağasi H, Bebek N, et al. Neurosyphilis presenting with status epilepticus. Epileptic Disord Int Epilepsy J Videotape 2007; 9 51–6.
| Neurosyphilis presenting with status epilepticus.Crossref | GoogleScholarGoogle Scholar |
[11] Clement ME, Okeke NL, Hicks CB. Treatment of Syphilis: a systematic review. JAMA 2014; 312 1905–17.
| Treatment of Syphilis: a systematic review.Crossref | GoogleScholarGoogle Scholar | 25387188PubMed |