[Headaches, otalgia and peripheral facial palsy as a form of presentation of neurosyphilis].
BACKGROUND
Decrease in incidence of neurosyphilis over the last few decades implies that clinicians consider less frequently this diagnosis. On the other hand, some reports suggest an increase in atypical forms of this disease that represent an additional reason for missing this diagnosis.


METHODS
We report on a 16 year-old immunocompetent black female from Guinea-Bissau presented with headaches, ear pain, hearing loss and peripheral facial paralysis. A cranial CT scan showed a hypodense area in the left cortico-subcortical zone and a contrast enhancement on the left pontocerebellar angle and internal auditory meatus. On the third day of admission a diagnosis of meningitis was made, with high titles of VDRL and TPHA in CSF and serum, leading to a diagnosis of neurosyphilis. The epidemiological aspects of this case suggest either a late congenital syphilis or an infection as a result of a blood transfusion administered seven years earlier in Guinea-Bissau.


CONCLUSIONS
This rare form of presentation of neurosyphilis emphasizes the importance of considering systematically this diagnosis, even in the context of atypical presentations.
Nunes da Silva
M J
MJ
Servicio de Medicina II, Hospital Universitário de Santa Maria, Lisboa, Portugal.
Oliveira
V
V
Sousa
A E
AE
Lucas
M
M
Victorino
R M
RM
D000293:Adolescent; D003056:Cochlear Nerve / Q000503:physiopathology; D003937:Diagnosis, Differential; D004433:Earache / Q000175:diagnosis* / Q000209:etiology*; D005154:Facial Nerve / Q000503:physiopathology; D005158:Facial Paralysis / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006261:Headache / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D009494:Neurosyphilis / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D014210:Treponema pallidum / Q000302:isolation & purification