Case 4-2022: A 55-Year-Old Man with Bilateral Hearing Loss and Eye Redness

Harris, Jeffrey P.; Ciaranello, Andrea; Tabb, Elisabeth S

doi:10.1056/nejmcpc2107349

Cited by 5 publications

(2 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All in all, on the one hand, the clinical manifestations of the disease are complex, and both MRI and CT results can be negative; on the other hand, Treponema pallidum, the pathogen of syphilis, is difficult to culture. Serological testing is the most common diagnostic method currently (Harris et al, 2022), and a negative serologic test can rule out neurosyphilis. However, no single test can be used to establish a diagnosis of neurosyphilis, an infection that can be easily missed or misdiagnosed (Du et al, 2021); a single specific deterministic testing remains lacking.…”

Section: Discussionmentioning

confidence: 99%

Neurosyphilis with ocular involvement and normal magnetic resonance imaging results affirmed by metagenomic next-generation sequencing

Zhou

Peng

Song

et al. 2022

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

The rapid and accurate identification of pathogenic agents is the key to guide clinicians on diagnosis and medication, especially for intractable diseases, such as neurosyphilis. It is extremely challenging for clinicians to diagnose neurosyphilis with no highly sensitive and specific test available. It is well known that the early transmission and immune evasion ability of Treponema pallidum have earned it the title of “stealth pathogen.” Neurosyphilis has complex clinical manifestations, including ocular involvement, which is infrequent and often overlooked, but its neuroimaging results may be normal. Therefore, it is important to find a new test that can detect the presence or absence of Treponema pallidum immediately for the diagnosis of neurosyphilis. We reviewed all the patients admitted to the Sichuan Provincial People’s Hospital between 2021 and 2022 who had ocular involvement and whose clinical samples were examined via metagenomic next-generation sequencing (mNGS), and we found 10 candidates for further analysis. The results of magnetic resonance imaging (MRI) were normal for four patients, and three of them met the diagnostic criteria for neurosyphilis confirmed by mNGS. In addition, the results of mNGS from the three patients were further validated using polymerase chain reaction (PCR). Five of the 10 patients had diplopia manifestations; two (20%) experienced abducens nerve palsies, two (20%) had eyelid drooping, and one (10%) had decreased vision. One of the 10 patients (10%) who was HIV positive and five patients had abnormal MRI results. To our knowledge, Treponema pallidum was detected by mNGS in patients with ocular involvement and normal MRI results for the first time. Given this situation, we recommend mNGS as a potential and supplementary tool for the diagnosis and differential diagnosis of neurosyphilis.

show abstract

Section: Discussionmentioning

confidence: 99%

Neurosyphilis with ocular involvement and normal magnetic resonance imaging results affirmed by metagenomic next-generation sequencing

Zhou

Peng

Song

et al. 2022

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

show abstract

“…Case 4-2022, Title: A 55-year-old man with bilateral hearing loss and eye redness 10 . Two terms (hearing loss and eye redness) were selected from the title for differential diagnostic query with each of the 3 diagnostic programs (Table 1).…”

Section: Case Studiesmentioning

confidence: 99%

Neurological Diagnosis

Finelli

2024

The Neurologist

View full text Add to dashboard Cite

Objective: Artificial intelligence has recently become available for widespread use in medicine, including the interpretation of digitized information, big data for tracking disease trends and patterns, and clinical diagnosis. Comparative studies and expert opinion support the validity of imaging and data analysis, yet similar validation is lacking in clinical diagnosis. Artificial intelligence programs are here compared with a diagnostic generator program in clinical neurology. Methods: Using 4 nonrandomly selected case records from New England Journal of Medicine clinicopathologic conferences from 2017 to 2022, 2 artificial intelligence programs (ChatGPT-4 and GLASS AI) were compared with a neurological diagnostic generator program (NeurologicDx.com) for diagnostic capability and accuracy and source authentication. Results: Compared with NeurologicDx.com, the 2 AI programs showed results varying with order of key term entry and with repeat querying. The diagnostic generator yielded more differential diagnostic entities, with correct diagnoses in 4 of 4 test cases versus 0 of 4 for ChatGPT-4 and 1 of 4 for GLASS AI, respectively, and with authentication of diagnostic entities compared with the AI programs. Conclusions: The diagnostic generator NeurologicDx yielded a more robust and reproducible differential diagnostic list with higher diagnostic accuracy and associated authentication compared with artificial intelligence programs.

show abstract

Atypisches Cogan-Syndrom als Differenzialdiagnose eines Hörsturzes

Salamat

Strieth²

2022

HNO

View full text Add to dashboard Cite

Case 4-2022: A 55-Year-Old Man with Bilateral Hearing Loss and Eye Redness

Cited by 5 publications

References 27 publications

Neurosyphilis with ocular involvement and normal magnetic resonance imaging results affirmed by metagenomic next-generation sequencing

Neurosyphilis with ocular involvement and normal magnetic resonance imaging results affirmed by metagenomic next-generation sequencing

Neurological Diagnosis

Atypisches Cogan-Syndrom als Differenzialdiagnose eines Hörsturzes

Contact Info

Product

Resources

About