Kiła układu nerwowego jako trudny problem w codziennej praktyce klinicznej – opis przypadku

Introduction. Syphilis still represents an important clinical problem.Involvement of the nervous system is one of the major features of latesyphilis, but may also occur in early syphilis.Objective. To present a case of neurosyphilis in relation to the currentproblems of diagnostics and therapy of Treponema pallidum infection.Case report. We present a 31-year-old woman with neurosyphilis. Atthe beginning the patient was treated with erythromycin, and twelvemonths later, because of insufficient decrease of titre of syphilis tests inthe serum, with doxycycline. Despite the second therapy the titres ofsyphilis tests remained high and therefore after another nine monthsthe patient was referred to our department for further diagnostics andtreatment. Because of the long course of the disease, high titres ofsyphilis tests in the serum and abnormalities in neurological examination(hypoaesthesia below the Th8 level, foot clonus and hyporeflexiain lower extremities) T. pallidum neuroinfection was suspected andcerebrospinal fluid was collected. The serological examination of cerebrospinalfluid revealed positive treponemal tests (FTA 1 : 10, TPHA++), while VDRL was negative. Based on the whole clinical presentationand laboratory abnormalities, neurosyphilis was diagnosed andtherapy with crystalline penicillin followed by procaine penicillin wasperformed.Conclusions. Neurosyphilis is characterized by rich symptomatologyand its diagnosis based only on clinical manifestation can be very difficult;particularly subtle symptoms may be easily overlooked. Therefore,evaluation of cerebrospinal fluid is necessary in all questionablepatients in order to establish a correct diagnosis.