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19 May 2022 : Case report  Latvia

[In Press] Neurosyphilis Mimicking Herpes Simplex Encephalitis on Magnetic Resonance Imaging: A Case Report

Challenging differential diagnosis, Rare disease

Arturs Balodis12ABCDEFG, Dagnija Grabovska13BCDEF, Ramona Valante ORCID logo4BDEF, Arina Novasa4BCD, Uldis Raits12DE

DOI: 10.12659/AJCR.936127

Am J Case Rep In Press; DOI: 10.12659/AJCR.936127  

Available online: 2022-05-19, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Neurosyphilis is a central nervous system infection caused by Treponema pallidum, that can develop at any time after the initial infection. The clinical signs of neurosyphilis are very variable, as well as its radiological features, and it is a diagnostic challenge. Knowledge of clinical symptoms and correct laboratory diagnostics, combined with routine radiological examination and additional diagnostic tools, such as high-resolution, three-dimensional FLAIR sequence, T2-weighted, and T1-weighted contrast-enhanced magnetic resonance imaging (MRI) are key to making an accurate diagnosis of neurosyphilis.
CASE REPORT
We present the clinical case of a patient who presented a 1-year history of vague clinical symptoms and was misdiagnosed with herpes simplex virus (HSV) encephalitis. Initial head MRI revealed extensive cerebral white matter lesions with cortical contrast enhancement, mainly of anterior and medial parts of the left temporal lobe, as typically seen in HSV encephalitis. Empirical therapy with acyclovir was started until a diagnosis of syphilis was confirmed with laboratory findings. Later, the therapy was changed to penicillin G. The patient’s condition improved after receiving targeted treatment. A control MRI scan was performed, and previously detected changes in the brain had decreased significantly.
CONCLUSIONS
MRI is the imaging of choice to support the diagnosis of neurosyphilis. Our findings suggest that neuroimaging can play an important role in indicating suspicion of syphilitic encephalitis. Enhancement of the anterior and medial parts of the temporal lobe is an atypical imaging finding, and it can simulate an infection with HSV. Early treatment is critical to a positive outcome.

Keywords: Magnetic Resonance Imaging; Neurosyphilis; Herpes Simplex Virus (HSV) Encephalitis; Atypical Imaging Finding

SARS-CoV-2/COVID-19

16 June 2022 : Case report  Ecuador

Multidrug-Resistant Klebsiella pneumoniae in a Patient with SARS-Cov-2 Pneumonia in an Intensive Care Unit ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936498  

13 June 2022 : Case report  Japan

Stenotrophomonas maltophilia Infection Associated with COVID-19: A Case Series and Literature Review

Am J Case Rep In Press; DOI: 10.12659/AJCR.936889  

13 June 2022 : Case report  Saudi Arabia

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

Am J Case Rep In Press; DOI: 10.12659/AJCR.936128  

03 June 2022 : Case report  Japan

Clinical Outcomes of Sotrovimab Treatment in 10 High-Risk Patients with Mild COVID-19: A Case Series

Am J Case Rep In Press; DOI: 10.12659/AJCR.936832  

In Press

24 Jun 2022 : Case report  USA

A 24-Year-Old Man Presenting with Lung Metastases from a Primary Retroperitoneal Extragonadal Choriocarcinoma

Am J Case Rep In Press; DOI: 10.12659/AJCR.936288  

24 Jun 2022 : Case report  Romania

Odontogenic Keratocyst: The Dos and Don’ts in a Clinical Case Scenario

Am J Case Rep In Press; DOI: 10.12659/AJCR.936641  

24 Jun 2022 : Case report  Saudi Arabia

Management of Patients with Alagille Syndrome Undergoing Living Donor Liver Transplantation: A Report of 2 ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936513  

22 Jun 2022 : Case report  USA

A Case of Lymphomatoid Granulomatosis in a Lymph Node with Unique Clinical and Histopathologic Features

Am J Case Rep In Press; DOI: 10.12659/AJCR.936862  

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