PDF(Pubmed)
Abstract：
BACKGROUND: Syphilis is associated with a wide variety of systemic presentations, earning it the moniker \"The great mimicker\". Neurosyphilis is classically associated with meningovasculitis in the acute-subacute stage and tabes dorsalis and dementia paralytica in later stages. However, one of the less well described presentations include Guillain-Barre Syndrome. This case presents a patient with an ascending polyneuropathy suspicious for Guillain-Barre Syndrome who also had other atypical findings including a truncal sensory loss, optic disc swelling, and rash ultimately found to have neurosyphilis. Electrodiagnostic testing was consistent with demyelination, supporting a diagnosis of neurosyphilis associated Guillain-Barre Syndrome.
METHODS: A 37-year-old female presented to the emergency department with a weakness and difficulty swallowing. She described a three-month history of symptoms, initially starting with a persistent headache followed by one month of a pruritic rash on her chest, palms, and soles. Two weeks prior to presentation, she developed progressive weakness in her arms, numbness in her arms and chest, and difficulty swallowing. Neurological exam was notable for multiple cranial neuropathies, distal predominant weakness in all extremities, length-dependent sensory loss, and hyporeflexia. Investigation revealed a positive Venereal Disease Research Laboratory in her cerebrospinal fluid without significant pleocytosis, contrast enhancement in cranial nerves V, VII, and VIII on MRI, and a demyelinating polyneuropathy on electrodiagnostic testing. She was diagnosed with Guillain-Barre syndrome, secondary to neurosyphilis. The patient acutely declined and required intubation, and ultimately made a full recovery after treatment with plasmapheresis and penicillin.
CONCLUSIONS: This case describes a clinical entity of syphilitic Guillain-Barre Syndrome and highlights the importance of including syphilis in the differential of any patient presenting with ascending polyradiculopathy, especially given the resurgence of syphilis.
METHODS: A 37-year-old female presented to the emergency department with a weakness and difficulty swallowing. She described a three-month history of symptoms, initially starting with a persistent headache followed by one month of a pruritic rash on her chest, palms, and soles. Two weeks prior to presentation, she developed progressive weakness in her arms, numbness in her arms and chest, and difficulty swallowing. Neurological exam was notable for multiple cranial neuropathies, distal predominant weakness in all extremities, length-dependent sensory loss, and hyporeflexia. Investigation revealed a positive Venereal Disease Research Laboratory in her cerebrospinal fluid without significant pleocytosis, contrast enhancement in cranial nerves V, VII, and VIII on MRI, and a demyelinating polyneuropathy on electrodiagnostic testing. She was diagnosed with Guillain-Barre syndrome, secondary to neurosyphilis. The patient acutely declined and required intubation, and ultimately made a full recovery after treatment with plasmapheresis and penicillin.
CONCLUSIONS: This case describes a clinical entity of syphilitic Guillain-Barre Syndrome and highlights the importance of including syphilis in the differential of any patient presenting with ascending polyradiculopathy, especially given the resurgence of syphilis.
摘要：
背景：梅毒与多种系统表现有关，为它赢得了“伟大的模仿者”的绰号。神经梅毒通常在急性亚急性阶段与脑膜血管炎有关，在后期与背囊和麻痹性痴呆有关。然而,描述较少的演讲之一包括格林-巴利综合征。该病例表现为怀疑格林-巴利综合征的进行性多发性神经病患者，他还具有其他非典型发现，包括躯干感觉丧失，视神经盘肿胀，皮疹最终被发现患有神经梅毒。电诊断测试与脱髓鞘一致，支持神经梅毒相关格林-巴利综合征的诊断。
方法：一名37岁女性因虚弱和吞咽困难出现在急诊科。她描述了三个月的症状史,最初是持续头痛，然后是一个月的胸部瘙痒皮疹，手掌,和鞋底。演讲前两周，她的手臂逐渐变得虚弱，她的手臂和胸部麻木，吞咽困难。神经系统检查对多发性颅神经病值得注意，所有四肢的远端主要弱点，长度依赖性感觉损失，和反射减退.调查显示，她的脑脊液中性病研究实验室呈阳性，没有明显的细胞增多，颅神经对比增强V,VII,MRI上的VIII，和电诊断性脱髓鞘性多发性神经病。她被诊断出患有格林-巴利综合征,继发于神经梅毒。病人急剧下降，需要插管，用血浆置换和青霉素治疗后最终完全康复。
结论：该病例描述了梅毒性格林-巴利综合征的临床实体，并强调了在任何表现为进行性多发性神经根病的患者中包括梅毒的重要性。尤其是梅毒的死灰复燃.
方法：一名37岁女性因虚弱和吞咽困难出现在急诊科。她描述了三个月的症状史,最初是持续头痛，然后是一个月的胸部瘙痒皮疹，手掌,和鞋底。演讲前两周，她的手臂逐渐变得虚弱，她的手臂和胸部麻木，吞咽困难。神经系统检查对多发性颅神经病值得注意，所有四肢的远端主要弱点，长度依赖性感觉损失，和反射减退.调查显示，她的脑脊液中性病研究实验室呈阳性，没有明显的细胞增多，颅神经对比增强V,VII,MRI上的VIII，和电诊断性脱髓鞘性多发性神经病。她被诊断出患有格林-巴利综合征,继发于神经梅毒。病人急剧下降，需要插管，用血浆置换和青霉素治疗后最终完全康复。
结论：该病例描述了梅毒性格林-巴利综合征的临床实体，并强调了在任何表现为进行性多发性神经根病的患者中包括梅毒的重要性。尤其是梅毒的死灰复燃.
