Late-onset congenital syphilis with unusual brain abnormalities

A 17-year-old woman presented with ataxia, refractory epilepsy and progressive cognitive decline since the age of eight. A brain MRI showed white matter abnormalities and atrophy ([Figures 1] and [2]). Her mother had positive tests for syphilis in her prenatal screening, but had not received any treatment. In our patient, serum VDRL (1:16) and IgG-FTA-ABS were positive. Her cerebrospinal fluid showed a slight increase in protein level, negative VDRL and positive FTA-ABS tests. Our diagnosis was late congenital syphilis with atypical brain abnormalities. We should be aware of this disorder and include it in the differential diagnosis of subacute neurological syndromes with frontal and temporal lesions on brain MRI[1],[2]..

Figure 1 Coronal T2 MRI sequence: brain atrophy and hyperintensities of the temporal and frontal lobes

Figure 2 Axial Flair MRI sequence: marked hyperintensities of the anterior temporal lobes.

Conflict of interest:

There is no conflict of interest to declare.

• References

• 1 Mignarri A, Arrigucci U, Coleschi P, Bilenchi R, Federico A, Dotti M. Temporal lobe abnormalities in neurosyphilis. Pract Neurol. 2014; 14 (6): 449-50. https://doi.org/10.1136/practneurol-2014-000927
• 2 Hama K, Ishiguchi H, Tuji T, Miwa H, Kondo T. Neurosyphilis with mesiotemporal magnetic resonance imaging abnormalities. Inter Med. 2008;47 (20): 1813-7.

Publication History

Received: 05 November 2016

Accepted: 04 July 2017

Article published online:
05 September 2023