Otosyphilis In An HIV-Infected Patient: The First Case in Vietnam

Syphilis has been re-emerging around the world, especially in MSM and people living with HIV. Because of the high number of infections, complications of the disease that were previously rare, now appear again. Otosyph-ilis is one of them. We reported a case of a 31-year-old MSM patient, HIV-positive, with sudden hearing loss of both ears and tinnitus due to syphilis. This is the first case of otosyphilis detected in Vietnam. The diagnosis of otosyphilis may be delayed because its symptoms are similar to those of other diseases. Therefore, there should be a highly suspected indicator of otosyphilis that can help clinicians orient the diagnosis and handle it in a timely manner.

Neurosífilis con neuropatía óptica y auditiva simultáneas en un paciente VIH positivo / Neurosyphilis with simultaneous optic and auditive involvement in an HIV-positive patient

Introducción: a partir del año 2000, los médicos han asistido a un retorno de la sífilis vinculado a prácticas sexuales no protegidas y con parejas múltiples, en especial entre hombres que tienen sexo con hombres. La coinfección Treponema pallidum/virus de la inmunodeficiencia humana (VIH) modifica tanto la historia natural de la sífilis, incrementando la incidencia de neurosífilis temprana, como la respuesta al tratamiento con penicilina. Métodos: un paciente varón, peruano, de 36 años, seropositivo para VIH, consulta por dis-minución de la agudeza visual en ojo derecho, pérdida de la audición, tinnitus, mareos y vértigo. Refería antecedentes de sífilis en los 2 años previos. Resultados: el examen oftalmológico efectuado al paciente mostró células en el segmento anterior del ojo derecho. El fondo de ojo reveló la existencia de inflamación del nervio óptico asociada con panuveítis. En base a los hallazgos clínicos, los valores de VDRL en suero y líquido cefalorraquídeo (LCR) se diagnosticó neurosífilis (NS) con neuritis óptica, panuveítis y otosífilis en un paciente coinfectado por VIH. El paciente fue tratado con penicilina G sódica intravenosa, 4 millones de UI cada 4 horas, durante 2 semanas con buena respuesta clínica. Discusión: el compromiso de los pares craneales óptico y auditivo puede representar la manifestación de una NS temprana, en especial, en el contexto de un paciente VIH positivo. De acuerdo con nuestro conocimiento, este sería el segundo caso publicado de compromiso simultáneo del nervio óptico y del aparato vestíbulo-coclear en un paciente con NS.

Introduction: from the 2000s, the physicians experienced a return of syphilis, which may be related to unrestricted sexual behaviour with unprotected contact between multiple partners, especially in men who have sex with men. Concurrent infection with human immunodeficiency virus (HIV) alters the natural history of syphilis by increasing the frequency of early neurosyphilis and the response to penicillin. Methods: a 36-year-old Peruvian man, seropositive for HIV infection, was admitted to the hospital with decreased visual acuity in his right eye, hearing loss, tinnitus, buzzing, and vertigo. He referred history of syphilis in the previous two years. Results: oph-thalmological examination was performed. Ocular anterior segment examination of the right eye showed cells. Fundoscopy revealed swelling of the right optic disc with panuveitis. Diagnosis of neurosyphilis (NS) with optic and ear neuritis, and concurrent HIV infection was made, based on the clinical manifestations and serum and cerebrospinal VDRL titers. The patient was treated with intravenous penicillin (four million units every four hours for two weeks) with an excellent clinical response. Discussion: simultaneous optic and auditive cranial nerve involvement can manifest early neurosyphilis (NS) and HIV coinfection. This is the second report to describe the simultaneous occurrence of syphilitic optic neuritis with vestibulocochlear nerve involvement.

Vertigo and sensorineural hearing loss due to syphilis: differential diagnosis and treatment / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the etiology of repeatedly attacks of intractable vertigo and some types of sensorineural deafness whose clinical manifestation were not in conformity with the known spectrum diseases，and explore the screening method to prevent missed diagnosis or misdiagnosis, then provide references for clinical diagnosis and treatment for rare etiology. Method:The authors retrospectively analyzed the clinical manifestations, diagnosis, treatment and prognosis from 4 cases of vertigo sufferers and 2 cases of hearing impairment sufferers whose serological tests were positive for syphilis. All these 6 cases were treated with large doses of penicillin aqueous solutions (24 million U/d), multi-times intravenous infusion, the course of the treatment was 14 d. Result:The clinical manifestations of these 6 patients were lack of characteristic, as well as the results of hearing and vestibular function, imaging diagnosis. Positive syphilis detection of serology and cerebrospinal fluid tests were the main diagnostic basis. After anti-syphilis treatment, 5 cases got satisfied clinical symptoms improvement, 1 case suffered from low-tone sensorineural hearing loss, whose hearing fluctuated recurrently. Conclusion:Syphilis infection may damage the Ⅷ cranial nerve and then lead to vertigo and hearing loss, through chronic syphilitic osteitis of temporal bone, atrophy of organ of corti, osteolytic lesion surrounding the endolymphatic duct, and neurosyphilis. For patients presented with intractable vertigo, and those whose clinical manifestations are not in conformity with the known diseases of unilateral ear or bilateral ears rapidly progressive deafness, syphilis serology screening and validation tests are recommended in case of missed diagnosis or misdiagnosis.

A Case of Bilateral Otosyphilis in the Patient with HIV Infection

Syphilis was a common cause of progressive or sudden sensorineural hearing loss. After introduction of penicillin, the incidence of syphilis decreased in general population. However, with the prevalence of HIV infection, it's incidence is increasing. Many studies have substantiated the aggressive and rapidly progressive behavior of neurosyphilis, including otosyphilis, in the presence of HIV infection . We report a case of 38-year-old man HIV infected patient with bilateral sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis which was resistant to treatment.