Late-onset congenital syphilis with unusual brain abnormalities

Sífilis congênita de início tardio com anormalidades encefálicas incomuns

A 17-year-old woman presented with ataxia, refractory epilepsy and progressive cognitive decline since the age of eight. A brain MRI showed white matter abnormalities and atrophy (Figures 1 and 2). Her mother had positive tests for syphilis in her prenatal screening, but had not received any treatment. In our patient, serum VDRL (1:16) and IgG-FTA-ABS were positive. Her cerebrospinal fluid showed a slight increase in protein level, negative VDRL and positive FTA-ABS tests. Our diagnosis was late congenital syphilis with atypical brain abnormalities. We should be aware of this disorder and include it in the differential diagnosis of subacute neurological syndromes with frontal and temporal lesions on brain MRI¹,²..

Figure 1
Coronal T2 MRI sequence: brain atrophy and hyperintensities of the temporal and frontal lobes

Figure 2
Axial Flair MRI sequence: marked hyperintensities of the anterior temporal lobes.

References

• ¹
  Mignarri A, Arrigucci U, Coleschi P, Bilenchi R, Federico A, Dotti M. Temporal lobe abnormalities in neurosyphilis. Pract Neurol. 2014; 14 (6): 449-50. https://doi.org/10.1136/practneurol-2014-000927
  » https://doi.org/10.1136/practneurol-2014-000927
• ²
  Hama K, Ishiguchi H, Tuji T, Miwa H, Kondo T. Neurosyphilis with mesiotemporal magnetic resonance imaging abnormalities. Inter Med. 2008;47 (20): 1813-7.

Publication Dates

• Publication in this collection
  Sept 2017

History

• Received
  05 Nov 2016
• Reviewed
  25 June 2017
• Accepted
  04 July 2017