Dados do Trabalho

Título

NEUROSYPHILIS MIMICKING MULTIPLES SCHWANNOMAS

Descrição sucinta do(s) objetivo(s)

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. Major forms of neurosyphilis include asymptomatic, acute syphilitic meningitis, meningovascular syphilitis, parenchymal and gummatous neurosyphilis.

História clínica

A 21-year-old man, presented with a two-month history of temporal headache and bilateral trigeminal nerves palsies and right oculomotor nerve palsy. An MRI showed enlargement and contrast enhancement of the bilateral trigeminal nerves e right oculomotor nerve, suggestive of a schwannomas. At this moment, he was diagnosed with HIV and the cerebrospinal fluid analysis disclosed: 12 cells/mm3 , protein 80 mg/dl, glucose 53 mg/dl and positive Venereal Disease Research Laboratory test (VDRL). Serum VDRL was 1/256 and the Treponema pallidum haemagglutination was positive.
The diagnostic of brain MRI was gummatous cranial nerves palsies. He was treated with IV crystalline penicillin G 2.400.000 U/day for 14 days with clinical and radiological improvement. There was complete resolution after treatment with crystalline penicillin G.

Discussão e diagnóstico

Syphilis is a sexually transmitted disease caused by the spirochete bacterium Treponema pallidum (T. pallidum). The clinical course of syphilis is divided into the following three stages; primary, secondary, and tertiary syphilis. The primary stage is characterized by a round painless sore, a chancre, at the inoculation site. Hematologic dissemination and the secondary syphilis occur within 2 to 4 weeks, if untreated. This clinical stage typically manifests as a rash on the palms of the hands and soles of the feet, and the CNS can be involved in the secondary stage observed as aseptic meningitis. Tertiary syphilis usually appears 5 years or more after the primary infection. Gummatous cranial nerve palsy is rarely as the sole manifestation of syphilis, but should be considered in the differential diagnosis of nerve tumors.

Conclusões

The incidence of neurosyphilis is rare, the MRI findings of the present case suggest that neurosyphilis should be considered in the differential diagnosis of shwannomas. It is necessary to maintain high suspicion regarding the clinical picture, and especially the specific radiological findings, as they are of the most importance in diagnostic differentiation.

Palavras Chave

Neurosyphilis; Cranial nerves; HIV

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