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25 September 2014 : Case report  USA

Acute Cranial Neuropathies Heralding Neurosyphilis in Human Immunodeficiency Virus-Infected Patient

Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)

Saeed AlqahtaniABCDEF

DOI: 10.12659/AJCR.892292

Am J Case Rep 2014; 15:411-415

Abstract

BACKGROUND: Symptomatic early neurosyphilis with isolated acute multiple cranial nerves palsy as initial manifestation of HIV infection is very rare. It is caused by direct invasion of the central nervous system by the spirochete Treponema pallidum.

CASE REPORT: A 31-year-old African-American homosexual man presented with bilateral hearing loss, constant vertigo, intermittent horizontal diplopia, and bilateral facial droop, which was associated with occipital headache without fever. Neurological examination revealed bilateral vestibulocochlear and facial nerve palsy. On brain magnetic resonance imaging (MRI) before and after administration of gadolinium, he was found to have extensive isolated basilar meningeal enhancement involving the midbrain, pons along the seven and eight nerves complex bilaterally, consistent with basal meningoencephalitis.

CONCLUSIONS: Neurosyphilis can present as initial manifestation of HIV infection with early involvement of basal meninges and cranial nerves. It is important to understand that neurosyphilis is still a significant disease with complex neurological presentation. Early diagnosis and treatment of neurosyphilis is crucial due to potential persistent disabilities that can be easily treated or even prevented.

Keywords: Cranial Nerve Diseases - etiology, Diagnosis, Differential, HIV, HIV Infections - virology, Homosexuality, Male, Magnetic Resonance Imaging, Neurosyphilis - microbiology, Treponema pallidum - isolation & purification

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923