Syphilitic meningoencephalitis associated with vasculitis

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Syphilitic meningoencephalitis associated with vasculitis

Lucas Alverne Freitas de Albuquerque^I; Renata Brant de Souza^I; Paulo Pereira Christo^II

^IInterns, Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil

^IIProfessor, Postgraduate Course, Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil

^{Correspondence to}

A 28 year-old man, with no previous comorbidity, presented left side weakness and verbal fluency reduction. A computed tomography (CT) (Figure 1) performed in another hospital revealed hipodensity in the basal ganglia. After 20 days the patient presented a generalized tonic-clonic seizure and became stuporous (Glasgow Coma Scale 11/15), with aphasia, anisocoria (right > left pupil) with mild light reaction (Argyll Robertson pupil), and tetraparesis (Medical Research Council Scale of Muscle Strength 2/5). Ten days later the patient was admitted at our service and a MRI revealed multiple areas of ischemia (Figure 2) suggestive of central nervous system vasculitis. Laboratorial evaluation revealed positive serology to HIV-1, HIV-1 RNA/mL 201.777 copies, CD4 count 97/mm³, serum VDRL 1/2048 and positive FTA-Abs. Cerebrospinal fluid analyses revealed 6 cells/mm³ (97% mononuclear), glucose 43 mg/dL, total protein 147 mg/dL and VDRL 1/16. The diagnosis of vascular meningoencephalitis syphilitic was made. The MRI was compatible with a case of Nissl-Alzheimer endarteritis syphilitica, a subtype that involves the small brain vessels^1-3. Despite initiation of specific treatment, the patient deteriorated to no visual or verbal contact, increase in muscle weakness (Muscle Strength 1/5) in the four limbs. After one month of medical support the patient died of a multi-resistent bacterial pneumonia.

Study conducted at Santa Casa de Belo Horizonte, MG, Brazil

• 1. Lucato LT, Barbosa Júnior A, Andrade CS, Amato Filho AC. Doenças infecciosas e inflamatórias do sistema nervoso central. In: Cerri GG, editor. Neurorradiologia: diagnóstico por imagem das alterações encefálicas. Rio de Janeiro: Guanabara Koogan; 2008. p.213-87.
• 2. Hajjaj I, Kissani N. Status epilepticus revealing syphilitic meningoencephalitis. Acta Neurol Belg 2010;110:263-7.
• 3. Gaa J, Weidauer S, Sitzer M, Lanfermann H, Zanella FE. Cerebral vasculitis due to Treponema pallidum infection: MRI and MRA findings. Eur Radiol 2004;14:746-7.

Publication Dates

• Publication in this collection
  14 Oct 2011
• Date of issue
  Oct 2011