Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis

被引:11
作者
Liao, Haibing [1 ]
Zhang, Yajing [1 ]
Yue, Wei [1 ]
机构
[1] Tianjin Huanhu Hosp, Dept Neurol, Tianjin, Peoples R China
关键词
neurosyphilis; encephalitis; leucine-rich glioma inactivated 1 protein; penicillin; case report; ANTIBODIES;
D O I
10.3389/fneur.2022.862175
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Neurosyphilis (NS) is an infection of the central nervous system caused by Treponema pallidum. It mimics various neurological and psychiatric diseases. In recent years, there have been several NS cases that manifest as limbic encephalitis (LE). Therefore, the diagnosis of neurosyphilis in the early stages is difficult. Here, we present a case of an NS patient who presented with LE manifestation. The 62-year-old woman presented with acute clinical manifestations of gibberish speech, poor memory, and seizures. Brain MRI showed abnormal signals on the right medial temporal lobe. In addition, the patient had a positive serum leucine-rich glioma inactivated 1 (LGI1) antibody with a titer of 1:16. Therefore, an initial diagnosis of anti-LGI1 encephalitis was made. However, further tests carried out showed positive rapid plasma reagin (RPR), and treponema pallidum particle agglutination (TPPA) tests both in the serum and the cerebrospinal fluid (CSF). Therefore, uncertainty arose as to whether the patient had both anti-LGI1 encephalitis and NS or whether the LGI1 antibody and LE manifestations were due to the NS. The patient was initiated on the recommended dose of penicillin G sodium. Following treatment, the patient reported a significant improvement in clinical symptoms, normal signals in the right temporal lobe, and a negative serum LGI1 antibody. These findings suggested that NS induced the LE manifestations and the production of the LGI1 antibody. This case demonstrates that testing syphilis in patients with LE is important and positive autoimmune encephalitis (AE) antibodies in NS patients need to be viewed and interpreted with greater caution.
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页数:6
相关论文
共 20 条
[1]   Neurosyphilis mimicking autoimmune encephalitis in a 52-year-old man [J].
Budhram, Adrian ;
Silverman, Michael ;
Burneo, Jorge G. .
CANADIAN MEDICAL ASSOCIATION JOURNAL, 2017, 189 (29) :E962-E965
[2]   Current clinical spectrum of neurosyphilis in immunocompetent patients [J].
Conde-Sendín, MA ;
Amela-Peris, R ;
Aladro-Benito, Y ;
Maroto, AAM .
EUROPEAN NEUROLOGY, 2004, 52 (01) :29-35
[3]   Neurosyphilis and brain magnetic resonance imaging [J].
Czarnowska-Cubala, Monika .
INTERNATIONAL JOURNAL OF DERMATOLOGY, 2015, 54 (07) :863-863
[4]   2020 European guideline on the management of syphilis [J].
Janier, M. ;
Unemo, M. ;
Dupin, N. ;
Tiplica, G. S. ;
Potocnik, M. ;
Patel, R. .
JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY, 2021, 35 (03) :574-588
[5]   Clinical and imaging findings in patients with neurosyphilis: a study of a cohort and review of the literature [J].
Khamaysi, Ziad ;
Bergman, Reuven ;
Telman, Gregory ;
Goldsher, Dorith .
INTERNATIONAL JOURNAL OF DERMATOLOGY, 2014, 53 (07) :812-819
[6]  
Mahawish K., 2014, BMJ CASE REP, V2014, pbcr2014204591, DOI [10.1136/bcr-2014-204591, DOI 10.1136/BCR-2014-204591]
[7]   Normalization of serum rapid plasma reagin titer predicts normalization of cerebrospinal fluid and clinical abnormalities after treatment of neurosyphilis [J].
Marra, Christina M. ;
Maxwell, Clare L. ;
Tantalo, Lauren C. ;
Sahi, Sharon K. ;
Lukehart, Sheila A. .
CLINICAL INFECTIOUS DISEASES, 2008, 47 (07) :893-899
[8]  
Marra Christina M, 2018, Handb Clin Neurol, V152, P151, DOI 10.1016/B978-0-444-63849-6.00012-8
[9]   Neurosyphilis in the mixed urban-rural community of the Netherlands [J].
Ouwens, Ingrid M. Daey ;
Koedijk, Femke D. H. ;
Fiolet, Aernoud T. L. ;
van Veen, Maaike G. ;
van den Wijngaard, Kees C. ;
Verhoeven, Willem M. A. ;
Egger, Jos I. M. ;
van der Sande, Marianne A. B. .
ACTA NEUROPSYCHIATRICA, 2014, 26 (03) :186-192
[10]   All that glitters is not gold: A limbic encephalitis due to neurosyphilis [J].
Pische, G. ;
Spitz, I. ;
Siffray-Bauer, L. ;
Dentel, C. ;
Perriard, J. ;
Carre, S. .
REVUE NEUROLOGIQUE, 2021, 177 (1-2) :156-157