ABSTRACT
With the incidence of syphilis more than doubling over the last decade, knowledge of its manifestations is of increasing importance. Yet, today's clinicians are less experienced in the recognition of syphilis than the physicians of Osler's day.In this case, a 56-year-old man presented with acute confusion and a history suggestive of encephalitis. Neuroimaging revealed cystic infarcts. He was subsequently tested for HIV and syphilis and found to be positive for both. HIV co-infection had accelerated the rate of neurosyphilis progression. After timely diagnosis and treatment of both conditions, cognitive testing returned to baseline.This case highlights that neuroimaging can often show non-specific infarcts and haemorrhages instead of characteristic syphilitic gummae. This variability adds to the challenge of diagnosis. Thus syphilis serology screening should be sent in those presenting with acute confusion and neuroimaging abnormalities. In cases of cryptogenic stroke, syphilis serology should be added to the screening tests.
Subject(s)
Neurosyphilis , Brain/diagnostic imaging , Brain/pathology , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Brain Ischemia/pathology , Diagnosis, Differential , HIV Infections/complications , HIV Infections/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurosyphilis/complications , Neurosyphilis/diagnostic imaging , Neurosyphilis/pathology , Stroke , Tomography, X-Ray ComputedABSTRACT
Kaposi sarcoma is a highly vascularised tumour affecting the skin, lymph nodes and viscera. Kaposi sarcoma is most common in HIV-infected homosexual or bisexual men. We present here a 70-year-old white British male patient, who was under the care of the podiatric team for longstanding 'diabetic foot ulcers'. He was later referred to the Dermatology team who took a biopsy; this revealed features of Kaposi sarcoma which prompted an HIV test which was positive. This patient had previously presented to several healthcare professionals with symptoms suggestive of HIV infection. He was started on antiretroviral therapy and the HIV and human herpesvirus-8 viral loads became undetectable in the blood within weeks and he showed significant clinical improvement. This case report is a reminder to clinicians to have a high index of suspicion in patients presenting with symptoms and signs suggestive of HIV infection.
Subject(s)
Diabetes Mellitus, Type 2/complications , Diabetic Foot/complications , HIV Infections/complications , Sarcoma, Kaposi/diagnosis , Skin Neoplasms/pathology , Ulcer/etiology , Adenine/analogs & derivatives , Adenine/therapeutic use , Aged , Antiretroviral Therapy, Highly Active , Biopsy , Deoxycytidine/analogs & derivatives , Deoxycytidine/therapeutic use , Diabetic Foot/drug therapy , Emtricitabine , HIV Infections/drug therapy , HIV Seropositivity/complications , HIV Seropositivity/drug therapy , HIV Seropositivity/pathology , HIV Seropositivity/virology , Herpesvirus 8, Human/drug effects , Herpesvirus 8, Human/isolation & purification , Humans , Male , Organophosphonates/therapeutic use , Sarcoma, Kaposi/drug therapy , Skin Neoplasms/drug therapy , Skin Neoplasms/virology , Tenofovir , Treatment OutcomeABSTRACT
The objective of this audit was to evaluate a localised rural outbreak of syphilis against British Association of Sexual Health and HIV guidelines. Forty-nine cases were identified; 98% were men, and 88% were men who have sex with men (MSM). There was a low incidence of HIV co-infection (18%). All standards regarding monitoring and treatment were met, whereas the standard concerning contact tracing was narrowly missed, highlighting a number of issues and areas for improvement. This audit has highlighted that a proactive approach is necessary to identify cases of syphilis in rural communities. This is due to difficulties in outreach testing and contact tracing in the absence of designated meeting places for MSM.
