Document 0816
 DOCN  M94B0816
 TI    [Cutaneous tertiary syphilis with neurological symptoms]
 DT    9412
 AU    Drobacheff C; Moulin T; Van Landuyt H; Merle C; Vigan M; Laurent R;
       Service de Dermatologie II, CHU Saint-Jacques, Besancon.
 SO    Ann Dermatol Venereol. 1994;121(1):34-6. Unique Identifier : AIDSLINE
       MED/94379678
 AB    INTRODUCTION. The tertiary cutaneous syphilis is now extremely rare. We
       report a case of tubercular cutaneous syphilis associated with
       neurological dysfunction. We emphasize the difficulties to interpret
       serologic and CSF tests for the diagnosis of neurosyphilis. CASE REPORT.
       A 63 year-old-woman had nodular, purplish and painless cutaneous lesions
       on forehead and forearm for 6 months. The biopsy showed a
       dermohypodermic lymphoplasmocytic granuloma, without necrosis, with
       endothelitis. Syphilis serologic tests were positive: VDRL = 512 U; TPHA
       = 40,960 U; FTA abs: IgG = 72,000 U; IgM = 1,350 U; Nelson test = 100 p.
       100 (1,200 U). HIV test was negative. There was a past history of a
       positive syphilis serologic test when the patient was 20-year-old. The
       patient complained of shaking and her family spoke of gradual mental
       deterioration and behaviour troubles. The neurological examination
       showed a major frontal syndrome, cerebellar dysfunction with dysarthria
       and a major labial and lingual tremor. There is no lymphocytosis nor
       increased protein in the CSF; VDRL test was negative, TPHA test was
       positive, FTA abs = 4,000 U (IgG), and TPHA was increased. Penicillin G
       16 millions units/day was given intravenously for 20 days; a slow
       increase was made in association with steroids at the beginning. The
       cutaneous lesions regressed in 14 days, but the neurologic state did not
       change. Six months later, there was still no IgM, TPHA decreased and
       VDRL was unchanged. DISCUSSION. While the diagnosis of tertiary
       cutaneous syphilis was correct, the neurological abnormalities are
       difficult to classify. The symptoms were those of general paresis, but
       there is no argument favouring biological CSF activity (no increase in
       protein or lymphocytosis, negative VDRL). Nevertheless, in the context
       of very positive serologic tests and tertiary cutaneous syphilis, we
       treated this case as a neurological syphilis. The treatment regimen and
       the need of current cures are still under discussion.
 DE    Case Report  English Abstract  Facial Dermatoses/*ETIOLOGY/PATHOLOGY
       Female  Human  Middle Age  Neurosyphilis/*COMPLICATIONS/DIAGNOSIS
       Penicillin G/THERAPEUTIC USE  Syphilis Serodiagnosis  Syphilis,
       Cutaneous/*COMPLICATIONS/DIAGNOSIS/DRUG THERAPY  Treatment Outcome
       JOURNAL ARTICLE

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