title: A case of neurosyphilis presenting with limbic encephalitis.
abstract: A 46-year-old man presented with a history of personality change and memory disturbance for 5 months. He gradually became difficult in doing a daily job. Brain MRI showed abnormal hyperintensity within bilateral mesial temporal lobes on T2weighted image. Therefore, viral and autoimmune limbic encephalitis was initially suspected. However, because treponemal and non-treponemal specific antibodies were positive in serum and cerebrospinal fluid (CSF), the diagnosis of neurosyphilis was made. Patients of neurosyphilis with mesiotemporal T2weighted hyperintensity reportedly showed common features such as relatively young age, HIV-negative, subacute cognitive impairment and seizure, as seen in our patient. Neurosyphilis should be included in the differential diagnosis for mesiotemporal abnormality in patients with these features. In addition, in our patient, anti-glutamate receptor ε2 antibody (ELISA) was strongly positive in CSF that suggested additional autoimmune pathophysiological mechanism.
authors.affiliation: Department of Neurology, Graduate School of Medicine, Kyoto University.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsukita
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shimotake
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Nakatani
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Akio
authors.initials: A
authors.lastname: Ikeda
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Takahashi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid; D001323:Autoantibodies / Q000134:cerebrospinal fluid; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D020363:Limbic Encephalitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D010400:Penicillin G / Q000627:therapeutic use; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology; D013702:Temporal Lobe / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D014210:Treponema pallidum / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D001323:Autoantibodies; D015415:Biomarkers; C121001:NR2B NMDA receptor; D016194:Receptors, N-Methyl-D-Aspartate; D010400:Penicillin G