Leroux M, Pasquet A, Baclet V, Alcaraz I, Melliez H, Cheret A
Service universitaire des maladies infectieuses et du voyageur, faculté de médecine, centre hospitalier, 135, rue du Président Coty, 59208 Tourcoing, France.
Ann Dermatol Venereol. 2013 Oct;140(10):619-22. doi: 10.1016/j.annder.2013.04.081. Epub 2013 May 17.
Syphilis has been making a comeback over the last 10 years. Neurosyphilis can occur at any stage of the infection but is difficult to diagnose because of the existence of misleading forms, of which we describe an example below.
A 56-year-old woman presented symptoms evoking polymyalgia rheumatica and giant-cell arteritis in a context of ibuprofen treatment for a few weeks. She also had myodesospsia, syphilids and syphilitic roseola, together with laboratory indicators of inflammation. A lumbar puncture revealed lymphocytic meningitis and a positive Treponema Pallidum Haemagglutination Assay (TPHA) for cerebrospinal fluid, thus confirming the diagnosis of neurosyphilis. Moreover, the ophthalmologic examination showed optic neuritis with papilla lesions of syphilitic origin. This was successfully treated with a 3-week course of penicillin G infusions.
Symptoms evocative of Horton's disease and polymyalgia rheumatica can reveal syphilis, a disease dubbed "the great simulator" on account of the variety of clinical forms it can take.
在过去10年中，梅毒发病率呈回升趋势。神经梅毒可出现在感染的任何阶段，但由于存在一些具有误导性的表现形式，其诊断较为困难，以下我们将描述一个病例。
一名56岁女性，在服用布洛芬数周后出现了提示风湿性多肌痛和巨细胞动脉炎的症状。她还伴有肌痛、梅毒疹和梅毒玫瑰疹，以及炎症的实验室指标。腰椎穿刺显示淋巴细胞性脑膜炎，脑脊液梅毒螺旋体血凝试验（TPHA）呈阳性，从而确诊为神经梅毒。此外，眼科检查显示视神经炎伴梅毒源性乳头病变。经3周的青霉素G静脉输注治疗后，病情得到成功控制。
提示霍顿病和风湿性多肌痛的症状可能揭示梅毒，由于其临床表现形式多样，梅毒被称为“伟大的模仿者”。
