An unusual cause for hyponatremia with seizures

Naha, Kushal; Vivek, G; Dasari, Sowjanya; Manthappa, M; Dias, Lorraine Simone; Acharya, Raviraja V

doi:10.1136/bcr.09.2011.4784

Cited by 5 publications

(1 citation statement)

References 7 publications

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“…The patient’s hyponatremia was attributed to SIADH, although it may have been confounded by the diagnosis of hypothyroidism. The second case was a patient who presented with a 10-day course of vomiting, seizures, and hyponatremia, ultimately found to have neurosyphilis [ 10 ]. The hyponatremia in this patient was suggestive of SIADH, but hypovolemic hyponatremia secondary to profound vomiting may have contributed.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Neurosyphilis Manifesting as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

et al. 2021

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Patient: Male, 56-year-old Final Diagnosis: Neurosyphilis Symptoms: Abdominal pain • constipation • nausea Medication: Penicillin Clinical Procedure: Colonoscopy with colon biopsy • CT scan • lumbar puncture • MRI Specialty: Infectious Diseases • Medicine, General and Internal Objective: Unusual clinical course Background: Syphilis has increased in prevalence in the United States by 72.7% from 2013 to 2017, with the highest rates recorded in men who have sex with men. There is an increased incidence of syphilis in patients with a concomitant HIV infection, estimated at a 77-fold increase. Case Report: This report documents an unusual case of neurosyphilis manifesting as syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a 56-year-old man with HIV/AIDS. A 56-year-old man who has sex with men with HIV/AIDS presented with a 4-day history of periumbilical abdominal pain, nausea, and constipation. A physical exam revealed slowing of baseline cognition, but was otherwise unremarkable. Urine and serum osmolality studies were consistent with SIADH as defined by the Bartter and Schwartz Criteria: serum osmolality <275 mOsm/kg, urine osmolality >100 mOsm/kg, urine sodium >20–40 mmol/L, euvolemia, and no other cause for hyponatremia identified. He was fluid-restricted, with improvement in laboratory abnormalities, further supporting the diagnosis of SIADH. A diagnostic work-up included a CT abdomen/pelvis with perirectal lymphadenopathy, colonoscopy negative for malignancy, chest CT with lymphadenopathy, and a head MRI negative for intracranial processes. The patient was ultimately found to have positive results on rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL) tests, and was diagnosed as having neurosyphilis. He underwent penicillin desensitization and received a 14-day course of penicillin G, with recovery of sodium to normal range on discharge. Conclusions: Our case highlights SIADH as an initial presenting sign of neurosyphilis with HIV infection, which has only been documented in 2 prior case reports. Our case highlights the importance of recognizing atypical presentations of neurosyphilis in patients with HIV to prevent long-term complications.

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Section: Discussionmentioning

confidence: 99%

An Unusual Case of Neurosyphilis Manifesting as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

et al. 2021

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An unusual diagnosis in a 31-year-old man with abdominal pain and hyponatremia

et al. 2018

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Changes in neurosyphilis presentation: a survey on 286 patients

Drago

Merlo

Ciccarese

et al. 2016

Acad Dermatol Venereol

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Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.

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An unusual cause for hyponatremia with seizures

Cited by 5 publications

References 7 publications

An Unusual Case of Neurosyphilis Manifesting as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

An Unusual Case of Neurosyphilis Manifesting as Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

An unusual diagnosis in a 31-year-old man with abdominal pain and hyponatremia

Changes in neurosyphilis presentation: a survey on 286 patients

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