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M94B0816.TXT
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1994-11-11
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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
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).