Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2024; 12(11): 1960-1966
Published online Apr 16, 2024. doi: 10.12998/wjcc.v12.i11.1960
Neurosyphilis complicated by anti-γ-aminobutyric acid-B receptor encephalitis: A case report
Ya-Xiu Fang, Xiao-Ming Zhou, Dong Zheng, Guang-Hui Liu, Peng-Bo Gao, Xiao-Zhen Huang, Zhi-Cheng Chen, Hui Zhang, Lin Chen, Ya-Fang Hu
Ya-Xiu Fang, Xiao-Ming Zhou, Dong Zheng, Peng-Bo Gao, Zhi-Cheng Chen, Hui Zhang, Lin Chen, Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
Guang-Hui Liu, Xiao-Zhen Huang, Ya-Fang Hu, Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong Province, China
Author contributions: Hu YF, Zheng D and Fang YX designed the study and drafted the manuscript; Fang YX and Zhou XM took care of the index patient and were responsible for the collection of clinical data; Liu GH conducted most of the experiments and obtained the TBA and CBA images. All authors have read and approved the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Fang Hu, MD, Doctor, Professor, Department of Neurology, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou 510000, Guangdong Province, China. yafanghu@smu.edu.cn
Received: December 17, 2023
Peer-review started: December 17, 2023
First decision: January 10, 2024
Revised: February 25, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 16, 2024
Processing time: 116 Days and 2.4 Hours
Abstract
BACKGROUND

Syphilis is an infectious disease caused by Treponema pallidum that can invade the central nervous system, causing encephalitis. Few cases of anti-N-methyl-D-aspartate receptor autoimmune encephalitis (AE) secondary to neurosyphilis have been reported. We report a neurosyphilis patient with anti-γ-aminobutyric acid-B receptor (GABABR) AE.

CASE SUMMARY

A young man in his 30s who presented with acute epileptic status was admitted to a local hospital. He was diagnosed with neurosyphilis, according to serum and cerebrospinal fluid (CSF) tests for syphilis. After 14 d of antiepileptic treatment and anti-Treponema pallidum therapy with penicillin, epilepsy was controlled but serious cognitive impairment, behavioral, and serious psychiatric symptoms were observed. He was then transferred to our hospital. The Mini-Mental State Examination (MMSE) crude test results showed only 2 points. Cranial magnetic resonance imaging revealed significant cerebral atrophy and multiple fluid-attenuated inversion recovery high signals in the white matter surrounding both lateral ventricles, left amygdala and bilateral thalami. Anti-GABABR antibodies were discovered in CSF (1:3.2) and serum (1:100). The patient was diagnosed with neurosyphilis complicated by anti-GABABR AE, and received methylprednisolone and penicillin. Following treatment, his mental symptoms were alleviated. Cognitive impairment was significantly improved, with a MMSE of 8 points. Serum anti-GABABR antibody titer decreased to 1:32. The patient received methylprednisolone and penicillin after discharge. Three months later, the patient’s condition was stable, but the serum anti-GABABR antibody titer was 1:100.

CONCLUSION

This patient with neurosyphilis combined with anti-GABABR encephalitis benefited from immunotherapy.

Keywords: Anti-γ-aminobutyric acid-B receptor; GABABR; Neurosyphilis; Tissue-based assay; Magnetic resonance imaging; Mini-mental state examination; Case report

Core Tip: In this report, we investigated the complex interplay between neurosyphilis and autoimmune encephalitis (AE), specifically anti-γ-aminobutyric acid-B receptor AE. Our findings shed light on the intricate connections between syphilis-related neurological complications and autoimmune responses, highlighting the potential significance of targeted immunotherapies in managing such cases. This investigation contributes valuable insights into the understanding and treatment of neurosyphilis, emphasizing the relevance of considering autoimmune mechanisms in its pathogenesis.