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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282XOn-line version ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.76 no.9 São Paulo Sept. 2018

http://dx.doi.org/10.1590/0004-282x20180100 

Letter

Reply

Resposta

Rodrigo Alencar e Silva1 

Camila Campelo1 

Clecio Godeiro Jr.1 

1Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Unidade de Distúrbios do Movimento, Natal RN, Brasil.


Dear Editor,

We would like to thank Dr Sriwijitalai and Prof Wiwanitkit1 for their comments and the opportunity to discuss more details about our publication “Late-onset congenital syphilis with unusual brain abnormalities”. Neurosyphilis is very challenging to diagnose due to its variable and complex presentation. This was a case report of a 17-year-old woman who presented with a refractory partial epilepsy since eight years of age and progressive cognitive decline. The patient had no history of sexual intercourse, autoimmune or chronic diseases. Tests for HIV infection, and PCR for herpes simplex were negative, serum VDRL (1:16) and the FTA-ABS test was positive in the cerebrospinal fluid with an increased protein level. False positive treponemal test results, like the FTA-ABS, occur less frequently than false positive anticardiolipin tests (VDRL) and the specificity of the FTA-ABS is high (1% false positive in the general population)2. The magnetic resonance imaging scan of her brain showed T2/FLAIR white matter hyperintensities and atrophy of the anterior temporal and frontal lobes. This image has seldom been reported in the literature in cases of neurosyphilis3,4. Her mother reported abnormalities in serological tests for syphilis in her prenatal screening. However, she did not receive any treatment. The test was repeated and her mother had VDRL (1:4), IgM-FTA-ABS and IgG-FTA-ABS positives. The patient was treated with intravenous crystalline penicillin, and there was better control of epilepsy.

Due to the evidences presented above, we believe that the diagnosis of late-onset congenital syphilis could be supported.

Yours sincerely,

Rodrigo Alencar e Silva

Camila Campelo

Clecio Godeiro Jr

References

1. Sriwijitalai S, Wiwanitkit V. Late-onset congenital syphilis: is it another disease? Arq Neuropsiquiatr 2018;76(9):xx-xx. https://doi.org/10.1590/0004-282X20180086Links ]

2. Nandwani R, Evans DT. Are you sure it's syphilis? A review of falso positive serology. Int J STD AIDS. 1995 Jul-Aug;6(4):241-8. [ Links ]

3. Mignarri A, Arrigucci U, Coleschi P, Bilenchi R, Federico A, Dotti M. Temporal lobe annormalities in neurosyphilis. Pract Neurol. 2014;14(6):449-50. https://doi.org/10.1136/practneurol-2014-000927Links ]

4. Hama K, Ishiguchi H, Tuji T, Miwa H, Kondo T. Neurosyphilis with mesiotemporal magnetic resonance imaging abnormalities. Inter Med. 2008 Feb;47(20):1813-7. [ Links ]

Received: August 24, 2018; Accepted: August 30, 2018

Correspondence: Rodrigo Alencar e Silva; Rua Henri Koster, 1029 / apt.1202; 59015-090 Natal RN, Brasil; E-mail: alencar-rodrigo@hotmail.com

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.