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Case Reports 2018
Medical Case Reports
ISSN: 2471-8041
Page 73
May 28-29, 2018
London, UK
8
th
Edition of International Conference on
Clinical and Medical Case Reports
N
eurosyphilis
can
cause
both
symptomatic
and
asymptomatic meningitis. Management of syphilis cases
can be complicated. Syphilis presenting with a skin rash and
an extremely high RPR titer could indicate CNS infection rather
than simply secondary syphilis, because rash is a non-specific
manifestation of disseminated infection. Here we present a case
of early neurosyphilis/symptomatic syphilitic meningitis in a non-
HIV patient who presented with rash and relatively high RPR titer
but was mistakenly treated for early latent or secondary syphilis.
A 24 y/o female with PMH of two STDs, non-recurrent genital
herpes and syphilis (treated with oral acyclovir) presented with
palmar rash at PCP’s office. Rash was diagnosed as secondary
syphilis (for extremely high RPR titer of 1:500). She was given
1.6 million units of benzathine PCN G intramuscularly. The rash
resolved in few weeks. Her rash recurred on the left hand 7
months after treatment. This time 2.4 million units of benzathine
penicillin given intramuscularly. The rash resolved in one to two
days. Follow up RPR titer in 4 weeks was 1: 16, a fold decline.
So further RPR follow up was not done. During the whole period
of her illness, the patient continued to have headaches, on and
off. Again, 8 months after, she presented to ER with dizziness
and persistent headache of two weeks duration and moderate
neck stiffness. Her serum VDRL titer was 1: 64. HIV rapid test
was non-reactive. Lumbar puncture showed leukocytosis with
lymphocytes 94%, quantitative CSF VDRL was reactive at 1:16.
CSF cultures showed no growth. Thus, the final diagnosis was
early symptomatic Neurosyphilis or syphilitic meningitis, which
would explain the persistent headache, vertigo, and recurrence of
rash secondary to inadequate prior treatment. PCN G, 4 million
units intravenously every four hours was started. The patient’s
symptoms resolved completely in 4 to 5 days. Thus, any RPR
titer > 1: 32 is highly suggestive of diseases of an active case of
replicating spirochetes.
shaguftaahsan@yahoo.comNeurosyphilis: an unresolved case of meningitis
Med Case Rep. 2018, Volume 4
DOI: 10.21767/2471-8084-C1-003
Shagufta Ahsan
Atlanticare Regional Medical Center,USA