Tabes dorsalis and syphilitic meningitis in a patient with human immunodeficiency virus

Abstract

Neurosyphilis is an infection caused by the bacterium Treponema pallidum subspecies pallidum (T. pallidum). It can occur at any time during the course of syphilis, and enters the body through the cousin-infection derived from primary chancre syphilitic, most patients generate an effective immune response that prevents the development of complications of infection in the CNS, however, some patients do not effectively eliminate the invasion to the CNS, thus developing asymptomatic or symptomatic neurosyphilis. It has been divided into early and late stages. The early stages include asymptomatic meningitis, symptomatic meningitis, gum syphilis, and meningovascular syphilis, while the late stages include paralytic dementia and tabes dorsalis. Since, to date, there is no highly specific and sensitive test, the diagnosis is based on clinical suspicion, serological studies, and the presence of CSF abnormalities. The importance in its diagnosis derives in avoiding the complications and potentially serious sequelae of the evolution of the disease without treatment. The management of neurosyphilis is limited to receiving penicillin therapy. Follow-up includes follow-up of serological and CSF tests in specific patients. Patients with co-infection with HIV may have an earlier development of neurological characteristics than people without the infection, as well as a high probability of an incomplete response to treatment. We present the case of a man in his fifth decade of life with human immunodeficiency virus (HIV) infection without antiretroviral therapy, with subacute fever, compromise of higher mental functions, Argyll Robertson pupil, myoclonus, and ataxic march. The treponemal tests developed in the hospitalization were positive, an abnormal CSF was obtained due to the presence of hyperprotein spinal cord, as well as anti-treponema pallidum antibodies in 6.56 positive in CSF, the diagnosis of tabes dorsalis was considered, for which treatment with penicillin was started intravenous crystalline 24 million international units (IU) day, for 14 days, with favorable clinical evolution. This article reviews the definition of aetiology, pathogenesis, clinical manifestations, diagnosis and treatment of neurosyphilis, with special attention to the presence of neurosyphilis with co-infection with HIV and its relevance to clinicians in the field of neurology.