Looks Like Neurosyphilis, Feels Like Guillain-Barre: At the Confluence of Infection and Immunology.

We present a 51-year-old male, with a past medical history of type 2 insulin-dependent diabetes mellitus (T2IDDM) without neuropathy, coronavirus disease 2019 (COVID-19) in April 2020 without residual symptoms, Raynaud's, and recent occupational outdoor exposure to insects as a construction manager who came to the emergency room complaining of a three-week history of bilateral progressive numbness and weakness beginning in his lower extremities and ascending toward his pelvis. Notably, he received the second dose of his Moderna COVID-19 vaccine one week prior to symptom onset and four weeks prior to admission. He also reported a recent appearance of a maculopapular rash on his upper extremities and flanks. Physical exam was remarkable for bilateral distal motor weakness in the upper and lower extremities with associated paresthesia and decreased reflexes in the lower extremities. The patient had slight ataxia and difficulty with heel walk and toe walk. Notably, the cranial nerve exam was normal, and the patient was afebrile. Intravenous immune globulin (IVIG) was started empirically for the treatment of Guillain-Barre syndrome (GBS), and doxycycline 100mg intravenous twice a day and ceftriaxone 2g intravenous daily were started for possible tick-borne disease. Subsequently, rapid plasma reagin (RPR) returned reactive at 1:64, and cerebral spinal fluid (CSF) venereal disease research laboratory (VDRL) test was reactive at 1:2 with markedly elevated protein and pleocytosis. Human immunodeficiency virus (HIV) testing was negative. Lyme disease testing was negative. Nerve conduction studies (NCS) and electromyography (EMG) showed a sensorimotor polyneuropathy with mixed demyelinating and axonal features. IVIG was continued for a total of five days, and antibiotics were changed to penicillin G (PCN G) for a total of 14 days for definitive treatment of early neurosyphilis (NS). While both clinical and laboratory findings confirm a positive diagnosis of NS, the patient's CSF composition showed very elevated total protein levels and pleocytosis. Additionally, his early peripheral neuropathy and EMG findings are not characteristics of a single disease and, instead, suggested a mixed pathology. We postulate that this patient had confirmed secondary syphilis with early NS associated with, and possibly correlated with, a simultaneous episode of acute inflammatory demyelinating polyneuropathy (AIDP) and/or a vaccine-related phenomenon.

Effects of selenomethionine on the gene expression profile of cloned human prostate cancer cells representing a phenotypic continuum of cancer progression.

We previously characterized three cell clones that were derived by limiting dilution from a human prostate cancer cell line (LNCaP) representing a phenotypic continuum of cancer progression (1). The present study was undertaken to examine the effects of L-selenomethionine (SeM), a potential cancer chemopreventive agent, on the gene expression profile of the cultured cell clones. Following a three-day incubation period with SeM, total RNA was extracted, and the gene expression profile was evaluated using Affymetrix human HG U133A microarrays and analyzed by ViaLogy's (Altadena, CA) VMAxS platform deploying quantum resonance interferometry (QRI) processing. The differentially expressed genes and corresponding biological processes were compared across the different treatments and cell types. Whereas SeM significantly affected RNA-DNA metabolism and protein transport and metabolism in all of the cell types evaluated, significant effects of SeM on genes mainly involved in the pathways of cell cycle, growth, differentiation, and apoptosis were observed only in the cell clone with a more malignant phenotype.

L-selenomethionine modulates high LET radiation-induced alterations of gene expression in cultured human thyroid cells.

L-selenomethionine (SeM) is emerging as a highly effective protective agent against radiation-induced biological effects. We have shown its protective effect on space radiation-induced death of MCF-10 cells as well as on space radiation-induced transformation of HTori-3 cells. The present study was aimed at elucidation of molecular mechanisms and cellular pathways involved in SeM-mediated radioprotection. Human thyroid epithelial cells (HTori-3 cells), in the presence or absence of SeM, were exposed to a non-toxic or a slightly toxic radiation dose from 1 GeV/n iron ions (10 cGy and 20 cGy, respectively). Total RNA was prepared and changes in gene expression were analyzed using microarray technology. Our analysis has revealed a dramatic effect of SeM on alterations of gene expression caused by space radiation. This study provides a basis for furthering our knowledge about radiation-induced molecular and cellular changes that lead to cellular transformation and death.

Neuromyelitis optica in patients with myasthenia gravis who underwent thymectomy.

BACKGROUND: Myasthenia gravis (MG) and neuromyelitis optica (NMO, also known as Devic disease) are rare autoimmune disorders, with upper-limit prevalence estimates in the general population of 15 per 100,000 and 5 per 100,000, respectively. To our knowledge, an association between these diseases has not been previously reported. OBJECTIVES: To describe 4 patients with MG who developed NMO after thymectomy and to analyze possible causes of apparent increased prevalence of NMO among patients with MG. DESIGN: Case series. PATIENTS: Four patients with MG who underwent thymectomy. INTERVENTIONS: None. RESULTS: The prevalence of MG within the published cohort of patients with NMO is more than 150 times higher than that in the general population. CONCLUSION: Dysregulation of B-cell autoimmunity in myasthenia, possibly exacerbated by loss of control over autoreactive cells as a result of thymectomy, may predispose patients to the development of NMO.