Treatment of Neurosyphilis with Ceftriaxone in a Patient Infected with Human Immunodeficiency Virus

Won-Keun Si; Kang-Heum Suh; Moon-Hyoung Lee; Bo-Kyoung Choi; Jin-Ah Hwang; Choon-Kwan Kim

doi:10.3947/ic.2011.43.3.262

Journal List > Infect Chemother > v.43(3) > 1035089

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Si, Suh, Lee, Choi, Hwang, and Kim: Treatment of Neurosyphilis with Ceftriaxone in a Patient Infected with Human Immunodeficiency Virus

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2011; 43(3): 262-265.

Published online: 29 June 2011

DOI: https://doi.org/10.3947/ic.2011.43.3.262

Treatment of Neurosyphilis with Ceftriaxone in a Patient Infected with Human Immunodeficiency Virus

Won-Keun Si, Kang-Heum Suh, Moon-Hyoung Lee, Bo-Kyoung Choi, Jin-Ah Hwang, Choon-Kwan Kim

Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea.

Correspondence to Choon-Kwan Kim. Department of Internal Medicine, Seoul Veterans Hospital, 6-2 Dunchon-dong, Gangdong-gu, Seoul 134-791, Korea. Tel: +82-2-2225-1491, Fax: +82-2-484-8709, schenics@naver.com

Received 19 November 2010 Revised 10 March 2011 Accepted 5 April 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The optimal and alternative antimicrobial regimens to treat neurosyphilis in human immunodeficiency virus (HIV) infected patients remain controversial. Little is known concerning the efficacy of ceftriaxone. A 75-year-old heterosexual man visited an outpatient clinic due to incidentally detected positive serum Venereal disease research laboratory (VDRL) and Fluorescent treponemal antibody absorbed tests in routine preoperative checkup. Because of benzathine penicillin was unavailable to use, 4-week regimen with doxycycline was started. After 2 weeks doxycycline treatment, a severe headache suddenly occurred. Cerebrospinal fluid (CSF) analysis showed mild lymphocyte-dominant pleocytosis, increased protein, and weakly reactive VDRL test. ELISA for HIV antibody and Western blot assay revealed he is infected with HIV. Initial CD4+ T cell count was 220/mm³ and the load of HIV RNA was 5,200 copies/mL. The most probable diagnosis was deemed to be neurosyphilis, considering the possibilities of Jarisch-Herxheimer reaction or doxycycline-induced pseudotumor cerebri. In the absence of procaine penicillin G in our hospital, intravenous ceftriaxone was administered and highly active antiretroviral therapy was started. After 14days of treatment, the patient no longer had a headache and the CSF profile was improved. Additional follow-up CSF analysis was done 3months after treatment. CSF pleocytosis and protein level were decreased and the CSF VDRL was converted to negative. Ceftriaxone may be a good alternative in the treatment of neurosyphilis in HIV infected patient.

Keywords: Neurosyphilis, Human immunodeficiency virus (HIV), Ceftriaxone

Figures and Tables

Table 1

Cerebrospinal Fluid (CSF) Parameters before and after Treatment with Ceftriaxone

^aN/C = not checked.

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