Sabbatani Sergio, Manfredi Roberto, Chiodo Francesco
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, S. Orsola Hospital, Via Massarenti II, 1-40138 Bologna, Italy.
Int J STD AIDS. 2005 Dec;16(12):832-4. doi: 10.1258/095646205774988181.
A rare episode of early neurosyphilis occurred in a 34-year-old, otherwise healthy, woman. Based on an isolated positive Borrelia burgdorferi serology (later interpreted as a cross-reaction), early ceftriaxone was initiated, in the suspect of Lyme borreliosis. Even after the diagnosis was corrected into that of a neurosyphilis, ceftriaxone administration was continued, until it achieved complete clinical and microbiological success after 24 days of treatment in a day-hospital setting, and three-weekly penicillin administrations. When considering the differential diagnosis, a luetic aetiology should not be underestimated when facing young patients with signs-symptoms of a meningoencephalitis. Our case report was characterized by an extremely low patient's age, compared with the occurrence of tertiary neurosyphilis, more than three years after the last sexual contacts. The diagnosis was confirmed by highly positive treponemal and non-treponemal serum and cerebrospinal fluid serology, and several suggestive clinical manifestations: seizures, altered mentation, cognitive impairment, lip drop, and anisochoria. These concomitant findings, together with a neuroradiological report indicating a diffuse meningoencephalitis, allowed us to confirm the diagnosis of neurosyphilis, together with a demonstrated cross-reaction of B. burgdorferi serology. Although ceftriaxone benefits from its once-daily administration (and can be easily delivered on outpatient basis), it is not the firstline treatment of neurosyphilis. However, our experience demonstrated a favourable and rapid response to ceftriaxone, in the absence of toxicity and disease sequelae.
一名34岁、身体健康的女性发生了罕见的早期神经梅毒病例。基于孤立的伯氏疏螺旋体血清学阳性结果（后来被解释为交叉反应），怀疑为莱姆病性疏螺旋体病，早期开始使用头孢曲松。即使在诊断纠正为神经梅毒后，仍继续使用头孢曲松，直到在日间医院环境中经过24天治疗以及每三周一次的青霉素给药后，取得了完全的临床和微生物学成功。在考虑鉴别诊断时，面对有脑膜脑炎体征和症状的年轻患者时，不应低估梅毒病因。与三级神经梅毒的发生相比，我们的病例报告的特点是患者年龄极低，距离上次性接触已超过三年。通过梅毒螺旋体和非梅毒螺旋体血清及脑脊液血清学高度阳性以及几种提示性临床表现（癫痫发作、精神状态改变、认知障碍、唇下垂和瞳孔不等大）确诊。这些伴随发现，连同一份表明弥漫性脑膜脑炎的神经放射学报告，使我们能够确诊神经梅毒，并证实了伯氏疏螺旋体血清学的交叉反应。尽管头孢曲松因其每日一次给药（且可在门诊轻松给药）而具有优势，但它并非神经梅毒的一线治疗药物。然而，我们的经验表明，在没有毒性和疾病后遗症的情况下，对头孢曲松有良好且快速的反应。
