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Abstract Details

Tabes Dorsalis in an HIV-infected Patient: a Case Report
Infectious Disease
P11 - Poster Session 11 (8:00 AM-9:00 AM)
13-005

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Neurosyphilis, the clinical consequence of Treponema pallidum nervous system infection, was ubiquitous in the past. There has been a resurgence of syphilis, but the diagnosis of neurosyphilis is overlooked because of its rarity. There is a higher prevalence of neurosyphilis among patients with HIV coinfection, who may also have earlier development of neurologic features, as well as incomplete responses to treatment.
A 51-year-old man diagnosed twenty years ago with HIV/ AIDS, complaining of two years of progressive instability associated with headache, visuospatial alteration, major depression and nocturia. Cranial magnetic resonance imaging (MRI) showed T2 and FLAIR hypersintensity and T1 bilateral hypointensity in the white matter, predominantly in the frontal and parietal lobes, T2 and FLAIR hyperintensity in the middle third of the cerebellar hemispheres and in the brainstem and an atrophy of the corpus callosum. Spinal cord MRI showed T2 hyperintensity from T6-7 to T11-12, without contrast enhancement. Electroneuromyography showed axonal distal symmetrical sensory neuropathy, affecting the lower limbs. He had ataxic gait, trunk and appendicular ataxia, distal hypopalesthesia and scored 21/30 in the Montreal Cognitive Assessment (MOCA) - impairment of language, visuospatial /executive functions and delayed recall. HIV viral load was of 127 copies and CD4 count was of 569 cells. Serum IgG FTA-Abs was reactive and 1/8 VDRL. Cerebrospinal fluid had a cloudy appearance, 35 cells (86% mononuclear), protein levels of 289 mg/dL and 1/2 VDRL. He was then treated with intravenous crystalline penicillin for 14 days and escitalopram, with a noticeable improvement of the gait, nocturia and cognitive status (28/30 in the last MOCA).
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Tabes dorsalis, despite its high historical prevalence, is a rare diagnosis nowadays. The increasing incidence of syphilis in the last years may turn again this scenario as a common one.
Authors/Disclosures
Caroline L. Medeiros, Jr., MD (Hospital Universitario Antonio Pedro)
PRESENTER 		Dr. Medeiros has nothing to disclose.
Luis Felipe Haberfeld Maia, MD (Universidade Federal Fluminense) No disclosure on file
No disclosure on file
Raisa Saron W. Murari, MD No disclosure on file
Sandra M. Torres, Sr., MD No disclosure on file
Naiade Couto, MD (Naiade Couto) Dr. Couto has nothing to disclose.
Arthur Ramalho Monfredinho, MD (University Hospital Antonio Pedro - Federal Fluminense University) Dr. Ramalho Monfredinho has nothing to disclose.
Caroline B. Braune, MD (Fluminense Federal University Department of Neurology) Dr. Braune has nothing to disclose.