Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Institute of Cardiocerebrovascular Disease, Shijiazhuang, China.
Eur J Med Res. 2022 Mar 27;27(1):49. doi: 10.1186/s40001-022-00676-1.
Neurosyphilis refers to infection of the central nervous system by Treponema pallidum. The clinical presentation is variable and nonspecific. Neuroimaging findings are complex and that the diagnosis is based on clinical presentation, cerebrospinal fluid (CSF) parameters, and serologic and CSF evidence of syphilis. To date, there is no case report describing Treponema pallidum detected by metagenomic next-generation sequencing (mNGS) in CSF.
In this report, we describe a case of neurosyphilis in a HIV-negative, 29-year-old man, who was admitted to our hospital with an epileptic seizure and progressive cognitive impairment. Brain magnetic resonance imaging (MRI) revealed fluid-attenuated inversion recovery (FLAIR) high signal intensities in bilateral medial and anterior temporal lobes, insula, right pulvinar of the thalami, precuneus, frontal and temporo-occipital lobes. Laboratory examination showed positive results by means of nontreponemal or specific treponemal test in serum and CSF. mNGS of the CSF was also performed to identify Treponema pallidum for the first time.
This case underscores the importance of considering neurosyphilis as a potential cause of mesiotemporal abnormality. In addition, the rapid improvement and wide usability of mNGS technology will bring new breakthroughs in the clinical diagnosis of neurosyphilis.
神经梅毒是指苍白密螺旋体感染中枢神经系统。临床表现多样且不具特异性。神经影像学表现复杂，诊断基于临床表现、脑脊液（CSF）参数以及梅毒的血清学和 CSF 证据。迄今为止，尚无描述 CSF 中苍白密螺旋体通过宏基因组下一代测序（mNGS）检测的病例报告。
本报告描述了一例 HIV 阴性的 29 岁男性神经梅毒病例，该患者因癫痫发作和进行性认知障碍而入院。脑磁共振成像（MRI）显示双侧内侧和前颞叶、岛叶、丘脑右侧豆状核、楔前叶、额叶和颞枕叶的液体衰减反转恢复（FLAIR）高信号强度。实验室检查显示血清和 CSF 中的非密螺旋体或特异性密螺旋体试验均呈阳性结果。CSF 的 mNGS 也是首次用于鉴定苍白密螺旋体。
本病例强调了将神经梅毒视为中颞叶异常的潜在原因的重要性。此外，mNGS 技术的快速改进和广泛可用性将为神经梅毒的临床诊断带来新的突破。
