SHM Converge Scientific Abstract ePoster Gallery-Penicillin Failure With Neurosyphilis

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This case describes a 72-year-old HIV-negative man with a one-year history of dizziness, gait instability, headache, and blurred vision. Workup showed a strongly positive RPR (1:256) and cerebrospinal fluid findings consistent with neurosyphilis, including reactive FTA-ABS, VDRL 1:8, elevated protein, low glucose, and mild pleocytosis. He was diagnosed with neurosyphilis and ocular syphilis (vitritis and chorioretinitis) and treated with IV penicillin G for two weeks.<br /><br />Despite treatment, his symptoms recurred, prompting repeat evaluations and additional courses of IV penicillin G. His RPR decreased only modestly over time (1:256 to 1:156 to 1:128), and he continued to develop neurologic and visual symptoms, including decreased right lower extremity sensation, wide-based gait, positive Romberg test, and worsening visual acuity bilaterally. This raised concern for treatment failure or relapse.<br /><br />The report highlights that penicillin G remains the standard therapy for all stages of syphilis, but true penicillin resistance in Treponema pallidum is not well defined. Because T. pallidum cannot be reliably cultured, cure is judged mainly by clinical improvement and a greater than fourfold fall in nontreponemal titers. Treatment failure is known to occur in some early syphilis cases, but data are limited for late syphilis and neurosyphilis.<br /><br />The main conclusion is that patients with suspected recurrent neurosyphilis require close follow-up, reassessment of the diagnosis, and consideration of retreatment when symptoms persist or recur despite standard therapy.

Asset Subtitle

Thea C. Amadasun

Meta Tag

Author List Maria Jesusa De Guzman, Thea C. Amadasun

Category Clinical Vignettes

Concept Neurosyphilis

Concept Penicillin G

Concept Nontreponemal titer

Concept Percentage Decline

Concept Syphilis

Distinguished Non-Finalist

Presenter Organization Cebu Institute of Medicine

Presenting Author Thea C. Amadasun

Track Adult

Keywords

neurosyphilis

ocular syphilis

Treponema pallidum

penicillin G

RPR titer

VDRL

FTA-ABS

treatment failure

relapse

chorioretinitis

Neurosyphilis

Penicillin G

Nontreponemal titer

Percentage Decline

Syphilis