Neurosyphilis complicated with pial arteriovenous fistula: A rare case report

INTRODUCTION: Neurosyphilis is a chronic, infectious disease of the central nervous system. Pial arteriovenous fistulae (PAVF) are rare vascular malformations. Both can cause vascular damage, but it is quite rare for both to present at the same time. PATIENT CONCERNS: Here we present a 66-year-old man with affective disorder, hypomnesia, and recent convulsions. Magnetic resonance imaging revealed cerebral swelling, hyperintensity in the cortex/subcortex, and multiple lacunar cerebral infarctions. Computed tomography angiography revealed the presence of a pial arteriovenous fistula. DIAGNOSES: Based on laboratory tests and imaging, diagnoses of neurosyphilis and pial arteriovenous fistula were made. INTERVENTIONS: Antisyphilis therapy was provided. OUTCOMES: Symptoms improved and antisyphilis treatment continued as an outpatient. No intracranial hemorrhage was seen 6 months later. CONCLUSION: Treponema pallidum infection may be related to the formation of PAVF, and may also promote the progression of it; however, further work is required to confirm this.