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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(06): 373-380
DOI: 10.1590/0004-282X20180054
ARTICLE

Neurosyphilis and ocular syphilis clinical and cerebrospinal fluid characteristics: a case series

Características clínicas e liqúoricas de pacientes com neurossífilis e sífilis ocular: uma série de casos
Conrado Regis Borges
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil;
,
Sérgio Monteiro de Almeida
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil;
3   Faculdades Pequeno Príncipe Curitiba, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba PR, Brasil.
,
Karen Sue
2   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neuro-Oftalmologia, Curitiba PR, Brasil;
,
Jéssyca Luana Alves Koslyk
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil;
,
Mario Teruo Sato
2   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neuro-Oftalmologia, Curitiba PR, Brasil;
,
Naoye Shiokawa
2   Universidade Federal do Paraná, Hospital de Clínicas, Serviço de Neuro-Oftalmologia, Curitiba PR, Brasil;
,
Hélio Afonso Ghizoni Teive
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brasil;
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ABSTRACT

Background During the first decade of this century, a significant increase in the incidence of syphilis was documented.

Objective To study clinical and laboratory characteristics of central nervous system and ocular syphilis.

Methods A retrospective case series of 13 patients with a clinical and laboratory diagnosis of neurosyphilis and/or ocular syphilis who had been admitted to the Neurology and Neuro-ophthalmology Service of the Hospital de Clínicas, Federal University of Paraná.

Results Nine patients had a diagnosis of neurosyphilis and two of them also had ocular syphilis. Four patients had a diagnosis of ocular syphilis alone. Among the patients with a diagnosis of neurosyphilis, six had symptomatic syphilitic meningitis, of whom one manifested as cranial nerve palsy alone, one as cranial nerve palsy plus ocular syphilis, two as transverse myelitis (syphilitic meningomyelitis), one as meningitis worsening the patient’s myasthenia gravis symptoms and one as meningitis plus ocular syphilis. Additionally, we diagnosed three patients with meningovascular neurosyphilis. In the univariate analysis, patients without ocular syphilis showed greater levels of total protein and white blood cells in the cerebrospinal fluid than patients with ocular syphilis.

Conclusion This Brazilian case series of patients with neurosyphilis and ocular syphilis highlights the wide variability of this disease. A high degree of diagnostic suspicion is necessary when facing neurological and ocular symptoms for rapid diagnosis and appropriate management of patients.

RESUMO

Introdução Na primeira década deste século observou-se um aumento significativo da incidência de sífilis no mundo.

Objetivo Estudar características clínicas e laboratoriais da sífilis no Sistema Nervoso Central e da sífilis ocular.

Métodos Estudou-se, retrospectivamente, uma série de treze casos com diagnóstico clínico e laboratorial de neurossífilis e/ou sífilis ocular, admitidos aos Serviços de Neurologia ou Neuroftalmologia do Hospital de Clínicas da Universidade Federal do Paraná.

Resultados Nove pacientes tiveram diagnóstico de neurosífilis e dois destes apresentaram concomitantemente sífilis ocular. Quatro pacientes tiveram somente o diagnóstico de sífilis ocular. Dos pacientes com diagnóstico de neurosífilis, seis apresentaram meningite sifilítica sintomática, dentre os quais um se apresentou com paralisia isolada de par craniano, um com paralisia de par craniano associada sífilis ocular, dois com mielite transversa (manifestação de meningomielite), um com meningite que agravou sintomas de Miastenia Gravis e um com meningite isolada associada a sífilis ocular. Houve 3 casos de neurosífilis meningovascular. Na análise univariada, pacientes sem manifestações oculares de sífilis apresentaram maiores níveis proteína total e leucócitos do que os pacientes com sífilis ocular.

Conclusão Essa série brasileira de casos de pacientes com neurosífilis e sífilis ocular destaca a alta variabilidade clínica desta doença. Alto grau de suspeição diagnóstica é necessário quando em frente a sintomas neurológicos e oculares para rápido diagnóstico e adequado manejo dos pacientes.

syphilis - neurosyphilis, ocular syphilis
Sífilis - neurossífilis, sífilis ocular


Publication History

Received: 16 December 2017

Accepted: 19 March 2018

Article published online:
25 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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