Peer Reviewed

Photoclinic

Syphilitic Meningitis

Volume 60 - Issue 1 - January 2020

  • Authors:
    Kate Bayliss, MD, PhD
    Resident Physician, Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio

    Lauren Orabi, MD
    Assistant Professor, Case Western Reserve University, and Attending Physician, Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio

    David Effron, MD
    Associate Professor, Case Western Reserve University, and Attending Physician, Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, Ohio

    Citation:
    Bayliss K, Orabi L, Effron D. Syphilitic meningitis. Consultant. 2020;60(1):26-29. doi:10.25270/con.2020.01.00004

     

    A 27-year-old man presented to the emergency department (ED) for a headache that had been present for 2 weeks. He reported that the headache was dull, varying in intensity throughout the day, worse in the morning and after work, associated with occasional light sensitivity and shoulder stiffness, and relieved by heat packs and ibuprofen. He additionally reported having night sweats, chills, fatigue, occasional blurry vision, and a 3-lb (1.4-kg) unintentional weight loss in the past month. He denied fever, nausea or vomiting, focal weakness, paresthesia, back pain, gait problems, and incontinence. He presented because his headache had become unresponsive to ibuprofen.

    History. He had no history of trauma, recent travel, sick contacts, or autoimmune disease. His history was notable for a painless rash over his abdomen earlier in the year and a sexual history of unprotected intercourse with a man 2 years prior, with concern for sexually transmitted disease (STD) exposure but no testing. He denied urinary symptoms, genital lesions or pain, and discharge.

    Physical examination. At presentation, the patient appeared thin but in no acute distress. His vital signs were normal except for mild tachycardia of 109 beats/min and a low-grade fever of 37.7°C. He had white exudates in his oropharynx, which scraped off with a tongue blade; hyperpigmented scars over the right T12 dermatome consistent with remote herpes zoster (Figures 1 and 2); a maculopapular rash on his shins bilaterally; and calluses with areas of hyperpigmentation on the soles of his feet (Figures 3 and 4).

    Fig 1
    Figure 1

    Fig 2
    Figure 2

    Fig 3
    Figure 3

    Fig 4
    Figure 4

    Neurological examination findings were normal, including negative Brudzinski and Kernig signs. He had no vision defects, and his neck was supple with full range of motion.

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