SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Advanced Neurosyphilis in the Setting of Pseudomonas Putida Meningitis

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This case describes a 57-year-old woman with three months of progressive confusion, weight loss, and decreased oral intake, followed by three weeks of paranoia, hallucinations, disorganized behavior, urinary incontinence, unsteadiness, dysphagia, and odynophagia. On exam she had minimally reactive miotic pupils and bilateral lower-extremity hypotonia with hyperalgesia. Workup showed a low vitamin B12 level, negative HIV testing, a very high serum RPR titer (1:512), and positive syphilis antibodies. Brain imaging revealed ventriculomegaly and chronic ischemic changes. CSF testing was notable for a reactive VDRL titer of 1:16 and reactive treponemal antibody testing, supporting neurosyphilis.<br /><br />During hospitalization, she was empirically treated with IV penicillin G for 14 days. CSF culture later grew Bactrim-resistant Pseudomonas putida, prompting a three-week course of IV cefepime. She also underwent EGD for dysphagia, which revealed H. pylori infection, and ophthalmologic evaluation found no uveitis.<br /><br />The authors emphasize that rapidly progressive cognitive and behavioral decline can occur in both meningovascular and parenchymal neurosyphilis. They note that CSF VDRL is highly specific and more useful for diagnosis, while FTA-ABS is highly sensitive but less specific. The presentation was felt to be consistent with late paretic neurosyphilis, though imaging also suggested possible meningovascular involvement. The authors conclude that her neuropsychiatric symptoms were likely due to a combination of neurosyphilis and Pseudomonas meningitis. She improved significantly with treatment, but after discharge to a nursing facility without proper antibiotic administration, she worsened and required retreatment.

Asset Subtitle

Myah L. McCrary

Meta Tag

Author List Keniesha Thompson, Myah L. McCrary

Category Clinical Vignettes

Concept Neurosyphilis

Concept Penicillin G

Concept Cognitive Decline

Concept Cerebrospinal Fluid Venereal Disease Research Laboratory Test

Concept Paranoia

Distinguished Non-Finalist

Presenter Organization Saint Louis University Department of Internal Medicine

Presenting Author Myah L. McCrary

Track Adult

Keywords

neurosyphilis

late paretic neurosyphilis

rapidly progressive dementia

positive RPR

CSF VDRL

psychiatric symptoms

hallucinations

Pseudomonas meningitis

penicillin G

ventriculomegaly

Neurosyphilis

Penicillin G

Cognitive Decline

Cerebrospinal Fluid Venereal Disease Research Laboratory Test

Paranoia