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Response to Penicillin for Presumed Neurosyphilis in a Patient with Human Immunodeficiency Virus (HIV), a Normal CD4 Count, and an Undetectable Viral Load: A Case Report
Journal article   Open access

Response to Penicillin for Presumed Neurosyphilis in a Patient with Human Immunodeficiency Virus (HIV), a Normal CD4 Count, and an Undetectable Viral Load: A Case Report

Yasameen E. Muzahim, Muhammad S. Khan and Harold P. Katner
The American journal of case reports, Vol.22(1), pp.e932467-e932467
08/11/2021
DOI: 10.12659/AJCR.932467
PMCID: PMC8366570
PMID: 34379615
url
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366570View
Published (Version of record) Open Access

Abstract

Objective: Unusual clinical course Background: Neurosyphilis is a bacterial infection of the brain and the spinal cord, caused by Treponema pallidum. Its non-specific clinical presentation includes cognitive impairment and motor and/or sensory function compromise. Neurosyphilis infections in patients with HIV have increased over the past few years and many cases of neurosyphilis manifest in patients with HIV who have low CD4 T-cell counts and high viral loads (VL). However, there is extremely limited acknowledgement in the literature about neurosyphilis presentations in patients with HIV who have normal CD4 counts. Case Report: We present a neurosyphilis and HIV coinfection in a patient with a normal CD4 count and an undetectable VL. A 69-year-old woman with a medical history of HIV was on a prescribed antiretroviral treatment regimen. She presented in the Emergency Room in an unresponsive state, although this had been preceded by a period of rapidly progressive cognitive decline. Her brain computed tomography scan without contrast was unremark-able. Laboratory test results were within normal limits, except for a positive result for the microhemagglutina-tion assay for Treponema pallidum antibodies and rapid plasma regain (RPR) test, which was highly suggestive of neurosyphilis as a presumed diagnosis. She showed remarkable clinical improvement after the initiation of conventional treatment for neurosyphilis, which is a 14-day regimen of intravenous penicillin G. Conclusions: Given the broad neurological manifestations of neurosyphilis and its increasing incidence in patients with HIV, it is important to consider neurosyphilis in the differential diagnosis after ruling out other causes of encepha-lopathy, especially in patients with an undetectable VL and a normal CD4 count.
 General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology

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