A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

Toffanin, Tommaso; Miola, Alessandro; Follador, Halima; Ferri, Giovanni; Scupola, Nadia; Martino, Nicola Antonio; Baratto, Alessandra; Perini, Giulia

doi:10.1097/pra.0000000000000390

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Moreover, it has been reported that brain MRI in NS is often characterized by atrophy, white matter lesions, cerebral infarction and edema ( 4 ). So far, only a few cases have reported high signal intensity of the medial temporal lobe structure similar to LE on brain MRI ( 16 – 18 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis

Liao

2022

Front. Neurol.

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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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Section: Discussionmentioning

confidence: 99%

Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis

Liao

2022

Front. Neurol.

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“…In another case, Toffanin et al described the case of a 34-year-old woman with neurosyphilis limbic encephalitis who presented with Geschwind syndrome, which is characterized by hyperreligiosity and hypergraphia and mood disorder [ 28 ]. This was reversible with acoustic pulse therapy treatment with antibiotics.…”

Section: Reviewmentioning

confidence: 99%

A Narrative Review of the Many Psychiatric Manifestations of Neurosyphilis: The Great Imitator

Kaur,

Khanna

2023

Cureus

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Neurosyphilis is an infection of the central nervous system caused by the spirochete, Treponema pallidum . New syphilis infections have been increasing around the world each year. This disease was much of a concern in the pre-penicillin era, where when left untreated many cases progressed to tertiary syphilis which can commonly manifest as neurosyphilis. Of particular interest, neurosyphilis has been linked to masquerading itself as various psychiatric conditions. This narrative review focuses on exploring psychiatric manifestations of neurosyphilis as well as the importance of screening in psychiatric settings and clinicians maintaining high clinical suspicion of the disease. A systematic search was conducted for published articles from 2003 to 2023 using PubMed, EMBASE, and Google Scholar. A total of 66 articles met the criteria and were used for detailed analysis, where psychiatric manifestations and clinical progression of patients were discussed in detail. Psychiatric manifestations that were explored include dementia, delirium, depression, mania, personality changes, and psychosis. One of the most common manifestations of neurosyphilis appears to be severe neurocognitive impairment. There are also rare psychiatric conditions neurosyphilis mimics that have been described in literature such as Capgras syndrome and Geschwind syndrome. A narrative review of the literature revealed a low level of clinical awareness of neurosyphilis as a possible etiology of various psychiatric disorders. This resulted in delayed or inaccurate diagnosis and consequently delayed initiation of adequate treatment. Considering that many psychiatric manifestations of neurosyphilis are reversible with proper treatment, it is imperative to implement routine screening for syphilis among psychiatric patients.

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Neurosyphilis with a rare magnetic resonance imaging pattern confirmed by metagenomic next-generation sequencing: a case report

Liu

et al. 2022

Eur J Med Res

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Background Neurosyphilis refers to infection of the central nervous system by Treponema pallidum. The clinical presentation is variable and nonspecific. Neuroimaging findings are complex and that the diagnosis is based on clinical presentation, cerebrospinal fluid (CSF) parameters, and serologic and CSF evidence of syphilis. To date, there is no case report describing Treponema pallidum detected by metagenomic next-generation sequencing (mNGS) in CSF. Case presentation In this report, we describe a case of neurosyphilis in a HIV-negative, 29-year-old man, who was admitted to our hospital with an epileptic seizure and progressive cognitive impairment. Brain magnetic resonance imaging (MRI) revealed fluid-attenuated inversion recovery (FLAIR) high signal intensities in bilateral medial and anterior temporal lobes, insula, right pulvinar of the thalami, precuneus, frontal and temporo-occipital lobes. Laboratory examination showed positive results by means of nontreponemal or specific treponemal test in serum and CSF. mNGS of the CSF was also performed to identify Treponema pallidum for the first time. Conclusions This case underscores the importance of considering neurosyphilis as a potential cause of mesiotemporal abnormality. In addition, the rapid improvement and wide usability of mNGS technology will bring new breakthroughs in the clinical diagnosis of neurosyphilis.

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A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder

Cited by 3 publications

References 24 publications

Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis

Case Report: A Case Report of Neurosyphilis Mimicking Limbic Encephalitis

A Narrative Review of the Many Psychiatric Manifestations of Neurosyphilis: The Great Imitator

Neurosyphilis with a rare magnetic resonance imaging pattern confirmed by metagenomic next-generation sequencing: a case report

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