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Abstract Details

Neurosyphilis and VZV Encephalitis Coinfection Presenting as a Stroke Mimic
Infectious Disease
P10 - Poster Session 10 (5:30 PM-6:30 PM)
13-012

We aim to describe a unique case of neurosyphilis and varicella zoster virus (VZV) encephalitis.  
Acute presentations of neurosyphilis or viral encephalitis can present similarly to stroke, carry a high risk of morbidity, and unrecognized cases may be fatal. Treatment is supportive with specific antiviral therapy available for herpes simplex virus and VZV. A 14-day course of penicillin is recommended for neurosyphilis. Identification of these pathologic processes is an important step in the management of stroke mimics.
We describe a clinical case and performed a literature review via the PubMed database.
This is a 66-year-old man who presented with an acute onset of receptive aphasia and altered mental status that was initially diagnosed and treated as an acute ischemic stroke. He received tissue Plasminogen Activator (tPA) without improvement. Follow up brain magnetic resonance imaging (MRI) revealed bihemispheric temporal lesions and a left thalamic lesion that did not follow typical vascular distributions or an ischemic pattern on diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC) sequences, which suggested an alternative etiology. The patient was ultimately revealed to have a co-infection of VZV encephalitis and neurosyphilis. Cerebrospinal fluid (CSF) studies revealed neurosyphilis infection and elevated VZV titers. Acyclovir and penicillin treatment resulted in clinical and lesion improvement.
Neurosyphilis and VZV vasculitis/encephalitis may present clinically as an acute stroke (i.e. stroke mimic).  A stroke-like presentation can lead to the administration of tPA without symptom improvement. It is important to recognize and evaluate an alternative diagnosis in these cases to prevent the progression of mortality and morbidity, especially in cases obfuscated by the presence of co-infection.
Authors/Disclosures
Christopher T. Brewer, MD, PhD
PRESENTER 		An immediate family member of Dr. Brewer has received personal compensation for serving as an employee of Clinical Outcomes Solutions. An immediate family member of Dr. Brewer has received personal compensation for serving as an employee of Sprout Health Solutions.
Reza Bavarsad Shahripour, MD (University of California, San Diego (UCSD)) Dr. Bavarsad Shahripour has nothing to disclose.
Talal Aboud, MD (Northside Hospital) No disclosure on file