A case of neurological syphilis mimicking Horton's disease and polymyalgia rheumatica

• Published in: Annales de dermatologie et de vénéréologie Vol. 140; no. 10; pp. 619 - 622
• Main Authors: Leroux, M, Pasquet, A, Baclet, V, Alcaraz, I, Melliez, H, Cheret, A
• Format: Journal Article
• Language: French
• Published: France 01.10.2013
• Subjects: Asthenia - etiology; Biopsy; Diagnosis, Differential; Female; Giant Cell Arteritis - diagnosis; Hemagglutination Tests; Humans; Middle Aged; Morbidity - trends; Neurosyphilis - cerebrospinal fluid; Neurosyphilis - complications; Neurosyphilis - diagnosis; Neurosyphilis - drug therapy; Neurosyphilis - microbiology; Optic Neuritis - etiology; Penicillin G - therapeutic use; Polymyalgia Rheumatica - diagnosis; Syphilis - diagnosis; Syphilis - epidemiology; Temporal Arteries - pathology; Treponema pallidum - isolation & purification; Ocular syphilis; Horton; Polymyalgia rheumatica; Pseudopolyarthrite rhizomélique; Horton's disease; Anti-inflammatoires non stéroïdiens; Syphilis oculaire; Neurosyphilis; Non-steroidal anti-inflammatory drugs
• ISSN: 0151-9638
• DOI: 10.1016/j.annder.2013.04.081

Syphilis has been making a comeback over the last 10 years. Neurosyphilis can occur at any stage of the infection but is difficult to diagnose because of the existence of misleading forms, of which we describe an example below. A 56-year-old woman presented symptoms evoking polymyalgia rheumatica and giant-cell arteritis in a context of ibuprofen treatment for a few weeks. She also had myodesospsia, syphilids and syphilitic roseola, together with laboratory indicators of inflammation. A lumbar puncture revealed lymphocytic meningitis and a positive Treponema Pallidum Haemagglutination Assay (TPHA) for cerebrospinal fluid, thus confirming the diagnosis of neurosyphilis. Moreover, the ophthalmologic examination showed optic neuritis with papilla lesions of syphilitic origin. This was successfully treated with a 3-week course of penicillin G infusions. Symptoms evocative of Horton's disease and polymyalgia rheumatica can reveal syphilis, a disease dubbed "the great simulator" on account of the variety of clinical forms it can take.