A 39-year-old male patient with a third kidney transplant, several episodes of pneumonia and hepatitis C virus carrier. He travels exotically for two months, living at risk and without preventive measures.
He comes with back pain and fever.
In anamnesis, fever, itching and whitish secretion in the penis, maculopapular rash, paresthesia in the lower limbs and double vision.
On examination: blood pressure: 177/106 mmHg; temperature: 36.8 oC, heart rate: 120 bpm.
Maculopapular rash with palmoplantar extension, predominantly central.
Paralysis of the sixth left cranial pair, absence of deep osteotendinous reflexes, decreased strength in both lower limbs and dysesthesias.
Normal blood count and leukocyte formula; creatinine 1.8 mg %, ionogram and gas normal.
Test results are shown in Table 1.
1.
With the diagnosis of symptomatic neurosyphilis with meningitis and early treatment of osteonecrosis in the limbs, treatment with sodium penicillin G 24,000,000 IU by IV route was initiated for 3 weeks, with substantial improvement of the paralysis.
The patient was discharged after completing treatment, with controls every three months in outpatient consultation.
An improvement in all neurological symptoms and a decrease in TPHA (Treponema de Laboratoryd Researchum Haemaglutation As progressive) titers were observed after RPR (rapid plasmatic reflux) and VDRL (Venereal).
Currently, after 5 years of infection, the patient is completely asymptomatic.
