Clinical case of meningovascular syphilis in combination with HIV infection

Authors

  • S. Ya. Kyryliuk "Lviv Regional Clinical Hospital", Lviv, Ukraine,
  • T. I. Nehrych Lviv National Medical University named after Danylo Halytskyi, Lviv, Ukraine,
  • Ya. Ye. Sanotskyi "Lviv Regional Clinical Hospital", Lviv, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.3.169221

Keywords:

cerebral infarction, neurosyphilis, meningitis, HIV infection

Abstract

 

Purpose: to study the features of clinical course, diagnosis and treatment of meningovacular syphilis associated with HIV infection.

Materials and methods. Clinical case of meningovascular syphilis in the context of HIV infection in a 55-year-old man, methods of diagnosis and treatment.

Results. The article deals with a special case of meningovascular syphilis associated with HIV in the man of 55 years, as well as the features of the clinical course and treatment of this pathology are discussed based on the analysis of the professional literature data. The data of anamnesis, objective, laboratory and instrumental examination, results of patient's treatment are presented. It is noted that a stroke may be the first manifestation of neurosyphilis and HIV infection. Changes in the cerebrospinal fluid were accompanied by a slight increase in lymphocytes. Specific immunological examination of blood and liquor was the key to the diagnosis. Treatment with ceftriaxone has resulted in improvement of the patient's health condition and a regression of motor neurologic deficit.

Conclusions. Patients with HIV infection are vulnerable to cerebrovascular diseases due to various etiological factors. Meningovascular form of neurosyphilis may be the initial manifestation of syphilis in both HIV-positive and HIV-negative individuals. Due to the increased incidence of syphilis, as well as co-infection with HIV, it is recommended to examine young patients with a stroke of unknown etiology with a presence of undetermined neurological symptoms and changes in the cerebrospinal fluid for HIV and syphilis. Clinical manifestations of neurovascular syphilis tend to be regressed in the course of specific antibiotic therapy.

References

Pashkovskyi, V. M. (2011). Dyferentsiina diahnostyka pidtypiv ishemichnoho insultu. [Differential diagnosis of ischemic stroke subtypes]. Praktychna anhiolohiia, Special output. Retrieved from https://angiology.com.ua/ua-issue-article-395 [in Ukrainian].

Kalimullah, J., Hoe, Hui, Min, R., Yen, T. S., & Singh, S. R. (2018). Ischemic Stroke in an HIV Positive Patient: An Initial Presentation of Neurosyphilis. Case Reports in Neurological Medicine. Retrieved from https://doi.org/10.1155/2018/2410154

Inglot, M., Szymanek, A., Szymczak, A., Rymer, W., Pawłowski, T., Pacan, P., Szepietowski, J. C. (2013). Three Episodes of Brain Stroke as a Manifestation of Neurosyphilis in an HIV-infected Man. Acta Derm Venereol, 93(2), 216–256. doi: 10.2340/00015555-1482

Numao, A., Suzuki, K., Takekawa, H., Nakamura, T., Iwanami, H., Izawa, N., et al. (2014). Ischemic Stroke as the Initial Manifestation of Neurosyphilis in a Young Adult Patient Positive for Human. Immunodeficiency virus, EJCRIM, 1. doi: 10.12890/2014_000097

Rodionov, A. N. (2007). Syfillis [Syphilis]. Saint Petersburg : Piter. [in Russian].

Marra, C. M. (2015). Neurosyphilis. Continuum (Minneap Minn), 21(6 Neuroinfectious Disease), 1714–28. doi: 10.1212/CON.0000000000000250

Knudsen, R. P. (2017). Neurosyphilis. Overview of Syphilis of the CNS. Medscape. Retrieved from https://emedicine.medscape.com/article/1169231-overview

Sudheer, А., Mammen, V., Noor, El A., Ganesa, V. S., & Marai, A. (2009). Case of Neurosyphilis Presented as Recurrent Stroke. Oman Med J, 24(2), 134–136. doi: 10.5001/omj.2009.29

Liu, L.-L., Zheng, W. H., Tong, M. L., Liu, G. L., Zhang, H. L., Fu, Z. G., et al. (2012). Ischemic Stroke as a Primary Symptom of Neurosyphilis among HIV-negative Emergency Patients. Journal of the Neurological Sciences, 317(1–2), 35–39. doi: 10.1016/j.jns.2012.03.003

Abkur, T. M., Ahmed, G. S., Alfaki, N. O., & O'Connor, M. (2015). Neurosyphilis presenting with a stroke-like syndrome. BMJ Case Rep., 2015. doi: 10.1136/bcr-2014-206988

Chen, M.-H., Lin, C.-C., Lin, T.-Y., & Sung Y.-F. (2013). Neuro-syphilis, HIV Infection and Brainstem Infarction. Qjm, 106(11), 1039–040. doi: 10.1093/qjmed/hct125

Bucher, J. B., Golden, M. R., Heald, A. E., & Marra, C. M. (2011). Stroke in a patient with human immunodeficiency virus and syphilis treated with penicillin and antiretroviral therapy. Sex Transm Dis, 38(5), 442–444. doi: 10.1097/OLQ.0b013e3181ffa5d0

Masrour, S., Ellington, K., & Abdennadher, M. (2016). Stroke as Initial Manifestation of Neurosyphilis in an HIV Positive Patient. Retrieved from http://practicalneurology.com/2016/05/ stroke-as-initial-manifestation-of-neurosyphilis-in-an-hiv-positive-patient/

Lachaud, S., Suissa, L., & Mahagne, M. H. (2010). Stroke, HIV and meningovascular syphilis: study of three cases. Rev Neurol (Paris), 166(1), 76–82.

Chen, T-C., Wang, J.-H., & Tsai, T.C. (2017). Repeated episodes of acute stroke as manifestation of neurosyphilis in a well-controlled human immunodeficiency virus-infected patientdSuccessful treatment with ceftriaxone. Journal of the Formosan Medical Association, 116(9), 725–726. doi: 10.1016/j.jfma.2017.01.007

Janier, M., Hegyi, V., Dupin, N., Unemo, M., Tiplica, G.S., Potočnik, M., et al. (2014). European Guideline on the Management of Syphilis. J Eur Acad Dermatol Venereol, 28(12), 1581–93. doi: 10.1111/jdv.12734

Marra, C. M. (2000).Ceftriaxone as an Alternative to Penicillin for Neurosyphilis. Clin Infect Dis. Retrieved from https://www.jwatch.org/id200006010000011/2000/06/01/ceftriaxone-alternative-penicillin-neurosyphilis.

Spornraft-Ragaller, P., Abraham, S., Lueck, C., & Meurer, M. (2011). Response of HIV-infected patients with syphilis to therapy with penicillin or intravenous ceftriaxone. Eur J Med Res, 16(2), 47–51. doi: 10.1186/2047-783X-16-2-47

(2012). Unificovanui klinichnui protocol medychnoi dopomogu «Ishemichnyi insylt (extrena, pervunna, vtorunna [specialilizovana] meduchna dopomoga, medychna reabilitacia) [Unified clinical protocol for medical aid "Ischemic stroke (emergency, primary, secondary [specialized] medical aid, medical rehabilitation")]. Retrieved from http://mtd.dec.gov.ua/images/dodatki/2012_602/ 2012_602dod4ykpmd.pdf [in Ukrainian].

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How to Cite

1.
Kyryliuk SY, Nehrych TI, Sanotskyi YY. Clinical case of meningovascular syphilis in combination with HIV infection. Zaporozhye medical journal [Internet]. 2019May31 [cited 2024Apr.26];(3). Available from: http://zmj.zsmu.edu.ua/article/view/169221

Issue

No. 3 (2019)

Section

Case Reports

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