Novel and characteristic radiological features of neurosyphilis: a case series

• Published in: BMC neurology Vol. 24; no. 1; pp. 248 - 7
• Main Authors: Ohira, Kenji, Hashimoto, Nanako, Kanai, Daisuke, Inoue, Yukio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.07.2024; BioMed Central; BMC
• Subjects: Adult; Antigens; Arteritis; Autoimmune diseases; Blood tests; Bones; Brain research; Case Report; Central nervous system; Central nervous system diseases; Comparative analysis; Complications and side effects; Dementia disorders; Diagnosis; Disease; Ear canal; Edema; Encephalitis; Female; HIV; Human immunodeficiency virus; Humans; Infections; Inner ear; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Meningitis; Middle Aged; Nervous system; Neuritis; Neurosyphilis; Neurosyphilis - diagnosis; Neurosyphilis - diagnostic imaging; Neurosyphilis - drug therapy; Optic nerve; Optic neuritis; Optic Neuritis - diagnosis; Optic Neuritis - diagnostic imaging; Osteomyelitis; Osteosyphilis; Otosyhilis; Patients; Penicillin; Pregnancy; Proteins; Radiology; Risk factors; Serology; Syphilis; Syphilitic optic neuritis; Vasculitis; Vertigo; Visual acuity; Japan; Osteosyphilis; Otosyhilis; Syphilis; Syphilitic optic neuritis; Radiology; Case series; Neurosyphilis; Treponema pallidum
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-024-03762-5

Treponema pallidum can invade the central nervous system (CNS) early in its infection, causing neurosyphilis. Neurosyphilis typically presents with meningovasculitis in the acute or subacute phase, while tabes dorsalis and dementia paralytica are classical conditions in the later stages. However, syphilis is often misdiagnosed as other conditions such as tumors or autoimmune diseases including vasculitis and encephalitis, which is why the condition is known as "The Great Mimicker." The increasing incidence of syphilis in recent years emphasizes the importance of early diagnosis and treatment; however, its multiple clinical manifestations impose diagnostic challenges for clinicians because it resembles other diseases. In this case series, we present the impressive manifestations of neurosyphilis through three unique radiological presentations. Case 1 details optic nerve involvement in an HIV-positive male, where MRI and fundoscopic findings confirmed syphilitic optic neuritis. Case 2 describes a patient in her pregnancy initially suspected of acoustic neuroma on MRI, later diagnosed with syphilitic gumma affecting the inner ear canal. Case 3 is a young male with clinical features mimicking temporal arteritis, ultimately identified as skull osteomyelitis secondarily causing inflammation of the musculus temporalis and meningitis. These cases underscore the necessity of considering syphilis in differential diagnoses, given the diversity of its clinical presentations. Radiology plays an important role in avoiding unnecessary interventions. The increasing prevalence of recurrent syphilis imposes diagnostic challenges, emphasizing the importance of the early diagnosis and treatment of neurosyphilis by clinicians.