Zhou Jia, Wang Wenwen, Zhang Qiyu, Zhang Hanlin, Tang Keyun, Mao Chenhui, Li Mingli, Li Jun
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, People's Republic of China.
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
Infect Drug Resist. 2024 Oct 30;17:4773-4781. doi: 10.2147/IDR.S482264. eCollection 2024.
Syphilis, caused by , presents a diagnostic challenge due to its diverse clinical manifestations. Neurosyphilis has seen a resurgence in recent years, particularly among men who have sex with men and those living with HIV. Diagnosis of neurosyphilis in emergency settings is challenging due to its varied neurological presentations. This study aims to serve as a reference for dermatologists and neurologists in diagnosing and treating neurosyphilis.
This retrospective study analyzed patients who presented with neuropsychiatric symptoms and were ultimately diagnosed with neurosyphilis. These patients were collected from the emergency department in Peking Union Medical College Hospital between January 2018 and November 2023. The medical history, clinical symptoms, laboratory examinations, cranial MRI characteristics, and treatment regimens of these patients were investigated.
Among the included 12 neurosyphilis patients, memory deterioration was observed in 8 out of the 12 neurosyphilis patients. Diagnosis often resulted in delays, with misdiagnoses mainly including Alzheimer's disease, stroke, and epilepsy. Neuroimaging revealed various abnormalities, predominantly affecting ventricular and temporal regions. Treatment with penicillin-based regimens varied in compliance, with only a minority of patients adhering to guidelines. Treatment outcomes were inconsistent, with some patients experiencing irreversible neurological damage and fluctuating serum rapid plasma reagin (RPR) titers.
Diagnosis of neurosyphilis in the emergency department remains challenging, necessitating awareness of its varied neurological presentations. Enhanced diagnostic strategies are imperative to accelerate treatment initiation and improve outcomes for affected individuals.
梅毒由梅毒螺旋体引起，因其临床表现多样而带来诊断挑战。近年来，神经梅毒有所复发，尤其是在男男性行为者和艾滋病毒感染者中。由于神经梅毒的神经学表现多样，在急诊环境中对其进行诊断具有挑战性。本研究旨在为皮肤科医生和神经科医生诊断和治疗神经梅毒提供参考。
本回顾性研究分析了出现神经精神症状并最终被诊断为神经梅毒的患者。这些患者于2018年1月至2023年11月期间从北京协和医院急诊科收集。调查了这些患者的病史、临床症状、实验室检查、头颅磁共振成像特征和治疗方案。
在纳入的12例神经梅毒患者中，12例中有8例出现记忆力减退。诊断常常延迟，误诊主要包括阿尔茨海默病、中风和癫痫。神经影像学显示出各种异常，主要影响脑室和颞叶区域。基于青霉素的治疗方案的依从性各不相同，只有少数患者遵循指南。治疗结果不一致，一些患者出现不可逆的神经损伤，血清快速血浆反应素（RPR）滴度波动。
在急诊科诊断神经梅毒仍然具有挑战性，需要认识到其多样的神经学表现。必须加强诊断策略，以加快治疗启动并改善受影响个体的治疗结果。
