Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China.
Department of Neurology, Zhejiang Hospital, Hangzhou City, China.
J Int Med Res. 2023 Jun;51(6):3000605231153317. doi: 10.1177/03000605231153317.
Otosyphilis is a rare cause of audiovestibular dysfunction that can easily be misdiagnosed. Here, we report a rare case in which a patient presented with secondary benign paroxysmal positional vertigo (BPPV) 2 weeks after symptoms of otosyphilis appeared. The Dix-Hallpike test showed a classical response in the head-hanging left position. The patient was treated with intravenous penicillin G and the canalith repositioning maneuver, which completely resolved the vertigo. The patient's audiovestibular symptoms resolved gradually. The elevated cerebrospinal fluid (CSF) white blood cell (WBC) count returned to normal and the results of the particle agglutination (TPPA) test were negative at the 3-month follow-up. This report suggests that otosyphilis should be considered in the differential diagnosis of audiovestibular dysfunction in patients at risk. Additionally, clinicians should remain vigilant about the possibility of secondary BPPV in patients with otosyphilis who report positional vertigo.
耳梅毒是一种引起听觉-前庭功能障碍的罕见病因，容易误诊。本文报告 1 例耳梅毒患者，其在出现耳梅毒症状后 2 周出现继发性良性阵发性位置性眩晕（BPPV）。Dix-Hallpike 试验显示头悬左位时出现典型反应。患者接受静脉注射青霉素 G 和管石复位手法治疗，眩晕完全缓解。患者的听觉-前庭症状逐渐缓解。CSF 白细胞（WBC）计数升高，3 个月随访时，颗粒凝集（TPPA）试验结果转为阴性。该报告提示，对于有风险因素的听觉-前庭功能障碍患者，应考虑耳梅毒的鉴别诊断。此外，对于报告位置性眩晕的耳梅毒患者，临床医生应警惕继发性 BPPV 的可能。
