Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares, Hôpital Cochin, Paris, France.
Département d'imagerie morphologique et fonctionnelle, pôle neuro-sciences, Centre hospitalier Sainte Anne, Paris, France.
Am J Med. 2018 Dec;131(12):1516-1519. doi: 10.1016/j.amjmed.2018.06.005. Epub 2018 Jul 2.
Cerebral vasculitis caused by neurosyphilis is a re-emerging problem with diagnostic and treatment issues, especially for human immunodeficiency virus patients.
We present a case of relapsing syphilis-associated cerebral vasculitis, despite the recommended first-line antibiotic treatment, that was successfully treated with a second intravenous penicillin G course and corticosteroids.
A 50-year old man went to the emergency department for bilateral episodes of red and painful eyes with progressive but severe visual acuity loss. He was diagnosed with bilateral panuveitis and neurosyphilis favored by an unknown human immunodeficiency virus infection with a CD4 count of 236 mm. Despite appropriate and well-conducted treatment including intravenous penicillin G, short-term corticosteroid, and highly active antiretroviral therapy, a symptomatic relapse of the syphilis-associated cerebral vasculitis occurred. After a second course of penicillin and corticosteroids, he made a complete recovery.
Neurosyphilis and human immunodeficiency virus co-infection is a reappearing challenging situation that should be considered with care by physicians because recommended antibiotic treatment sometimes fails. Corticosteroid therapy should be discussed in case of cerebral vasculitis.
神经梅毒引起的脑血管炎是一个具有诊断和治疗问题的再发问题，特别是对于人类免疫缺陷病毒患者。
我们报告了一例复发性梅毒相关性脑血管炎的病例，尽管推荐了一线抗生素治疗，但第二疗程静脉注射青霉素 G 和皮质类固醇治疗后成功治愈。
一名 50 岁男性因双侧眼红和疼痛伴进行性但严重视力丧失而到急诊科就诊。他被诊断为双侧全葡萄膜炎和神经梅毒，原因是未知的人类免疫缺陷病毒感染，CD4 计数为 236mm。尽管进行了适当和良好的治疗，包括静脉注射青霉素 G、短期皮质类固醇和高效抗逆转录病毒治疗，但仍出现了梅毒相关性脑血管炎的症状复发。在第二疗程的青霉素和皮质类固醇治疗后，他完全康复。
神经梅毒和人类免疫缺陷病毒合并感染是一个重新出现的具有挑战性的情况，医生应该谨慎考虑，因为推荐的抗生素治疗有时会失败。在出现脑血管炎的情况下应讨论皮质类固醇治疗。
