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Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis

Neurosyphilis (NS) is an infection of the central nervous system caused by Treponema pallidum. It mimics various neurological and psychiatric diseases. In recent years, there have been several NS cases that manifest as limbic encephalitis (LE). Therefore, the diagnosis of neurosyphilis in the early...

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Autores principales: Liao, Haibing, Zhang, Yajing, Yue, Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133385/
https://www.ncbi.nlm.nih.gov/pubmed/35645969
http://dx.doi.org/10.3389/fneur.2022.862175
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author Liao, Haibing
Zhang, Yajing
Yue, Wei
author_facet Liao, Haibing
Zhang, Yajing
Yue, Wei
author_sort Liao, Haibing
collection PubMed
description Neurosyphilis (NS) is an infection of the central nervous system caused by Treponema pallidum. It mimics various neurological and psychiatric diseases. In recent years, there have been several NS cases that manifest as limbic encephalitis (LE). Therefore, the diagnosis of neurosyphilis in the early stages is difficult. Here, we present a case of an NS patient who presented with LE manifestation. The 62-year-old woman presented with acute clinical manifestations of gibberish speech, poor memory, and seizures. Brain MRI showed abnormal signals on the right medial temporal lobe. In addition, the patient had a positive serum leucine-rich glioma inactivated 1 (LGI1) antibody with a titer of 1:16. Therefore, an initial diagnosis of anti-LGI1 encephalitis was made. However, further tests carried out showed positive rapid plasma reagin (RPR), and treponema pallidum particle agglutination (TPPA) tests both in the serum and the cerebrospinal fluid (CSF). Therefore, uncertainty arose as to whether the patient had both anti-LGI1 encephalitis and NS or whether the LGI1 antibody and LE manifestations were due to the NS. The patient was initiated on the recommended dose of penicillin G sodium. Following treatment, the patient reported a significant improvement in clinical symptoms, normal signals in the right temporal lobe, and a negative serum LGI1 antibody. These findings suggested that NS induced the LE manifestations and the production of the LGI1 antibody. This case demonstrates that testing syphilis in patients with LE is important and positive autoimmune encephalitis (AE) antibodies in NS patients need to be viewed and interpreted with greater caution.
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spelling pubmed-91333852022-05-27 Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis Liao, Haibing Zhang, Yajing Yue, Wei Front Neurol Neurology Neurosyphilis (NS) is an infection of the central nervous system caused by Treponema pallidum. It mimics various neurological and psychiatric diseases. In recent years, there have been several NS cases that manifest as limbic encephalitis (LE). Therefore, the diagnosis of neurosyphilis in the early stages is difficult. Here, we present a case of an NS patient who presented with LE manifestation. The 62-year-old woman presented with acute clinical manifestations of gibberish speech, poor memory, and seizures. Brain MRI showed abnormal signals on the right medial temporal lobe. In addition, the patient had a positive serum leucine-rich glioma inactivated 1 (LGI1) antibody with a titer of 1:16. Therefore, an initial diagnosis of anti-LGI1 encephalitis was made. However, further tests carried out showed positive rapid plasma reagin (RPR), and treponema pallidum particle agglutination (TPPA) tests both in the serum and the cerebrospinal fluid (CSF). Therefore, uncertainty arose as to whether the patient had both anti-LGI1 encephalitis and NS or whether the LGI1 antibody and LE manifestations were due to the NS. The patient was initiated on the recommended dose of penicillin G sodium. Following treatment, the patient reported a significant improvement in clinical symptoms, normal signals in the right temporal lobe, and a negative serum LGI1 antibody. These findings suggested that NS induced the LE manifestations and the production of the LGI1 antibody. This case demonstrates that testing syphilis in patients with LE is important and positive autoimmune encephalitis (AE) antibodies in NS patients need to be viewed and interpreted with greater caution. Frontiers Media S.A. 2022-05-12 /pmc/articles/PMC9133385/ /pubmed/35645969 http://dx.doi.org/10.3389/fneur.2022.862175 Text en Copyright © 2022 Liao, Zhang and Yue. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Liao, Haibing
Zhang, Yajing
Yue, Wei
Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis
title Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis
title_full Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis
title_fullStr Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis
title_full_unstemmed Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis
title_short Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis
title_sort case report: a case report of neurosyphilis mimicking limbic encephalitis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133385/
https://www.ncbi.nlm.nih.gov/pubmed/35645969
http://dx.doi.org/10.3389/fneur.2022.862175
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