Simultaneously neurolues and secondary syphilis in renal transplanted and immunosuppressed patient in Brazil: a case report

Introduction:
Syphilis is an infectious disease with distinct clinicals characteristics. In immunosuppressive patients, it can be present with atypical manifestations. We will present a case of secondary syphilis with concomitance neurolues.

Clinical history and physical examination:
63-year-old man, with a kidney transplantation in immunosuppressive treatment was admitted to the emergency department for left hemiparesis started suddenly 3 days ago associated with diffuse maculopapular lesions (Figure 1).

Investigation:
Brain CT-scan showed a subacute hypodensity of the right parietal region (Figure 2). Cerebral spinal fluid (CBF) showed 153mg/dL protein level, normal glucose and no pleocytosis. Serologic blood and CBF test showed negative nontreponemal test. After five days, nontreponemal tests were positive. The diagnosis of neurolues was made and ceftriaxone was initiated.

Discussion:
This case shows a combined presentation of neurolues with secondary syphilis. In the beginning, patient presented with negative nontreponemal serology on plasma and CBF, besides clinical findings compatible with secondary syphilis. This phenomenal is called by prozone effect because high antibody titer. In immunosuppressive patient, the etiology of stroke involves a broader differential diagnosis and infectious diseases enter into these possibilities.