PSİKİYATRİK BELİRTİLER İLE BAŞVURAN NÖROSİFİLİZ: BİR OLGU SUNUMU

Sifiliz, Treponema Pallidum adlı spiroketle cinsel yolla bulaşan enfeksiyöz bir hastalıktır. Santral sinir sistemi tutulumu her dönemde gözlenebilir. Depresyon, mani, deliryum, demans ve kişilik değişiklikleri gibi çok sayıda psikiyatrik bozukluklara benzer klinik görünümlere neden olabilen nörosifiliz tanı ile ilgili değerlendirmelerde bazı güçlüklere neden olabilmektedir. Bu nedenle özellikle ani ve geç başlangıçlı nörolojik ve psikiyatrik bozuklukların ayırıcı tanısında nörosifiliz düşünülmelidir. Her ne kadar günümüzde antibiyotiklerin yaygın kullanımı ile nadir olarak görülse de nörosifilizin erken tanı ve tedavisi önemlidir. Genellikle birincil enfeksiyondan 4-10 yıl sonra, tedavi edilmeyen veya yetersiz tedavi gören olgularda nörosifiliz riski artmıştır Bu yazıda geç başlangıçlı mani belirtileri ile servisimize kabul edilen ve tetkikleri sırasında nörosifiliz tanısı konulan 50 yaşındaki kadın olgu literatür bulguları eşliğinde tartışılarak, mevcut yazına katkı sunulması amaçlanmıştır.

Anahtar Kelimeler:

Nörosifiliz, Psikiyatrik belirti, Treponema Pallidum

NEUROSYPHILIS PRESENTING WITH PSYCHIATRIC SYMPTOMS: A CASE REPORT

Syphilis is an infectious disease transmitted sexually by spirochetes called Treponema Pallidum. Central nervous system involvement can be observed in any period. Neurosyphilis, which can cause clinical manifestations similar to many psychiatric disorders such as depression, mania, delirium, dementia and personality changes, may cause some difficulties in diagnostic evaluations. Therefore, neurosyphilis should be considered in the differential diagnosis of especially sudden and late-onset neurological and psychiatric disorders. Although it is rarely seen today with the widespread use of antibiotics, early diagnosis and treatment of neurosyphilis is important. In this paper, it is aimed to contribute to the current literature by discussing the case of a 50-year-old female patient who was admitted to our service with late-onset mania symptoms and was diagnosed with neurosyphilis during the examinations, in the light of the literature findings.

Keywords:

Neurosyphilis, Psychiatric Symptom, Treponema Pallidum,

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1. Ghanem KG. Neurosyphilis: a historical perspective and review. CNS Neurosci Ther 2010;16(5):157–68.
2. Timmermans M, Carr J. Neurosyphilis in the modern era. J Neurol Neuro surg Psychiatry 2004;75(12):1727–30.
3. Nguyen TV, Kompanje EJ, van Praag MC. A few milestones in the history of syphilis. Ned Tijdschr Geneeskd 2013;157(12):A6024.
4. Gökengin D. Nörosifiliz. Turkiye Klinikleri J Int Med Sci 2006;2(28):94-9.
5. Karp G, Schlaeffer F, Jotkowitz A, Riesenberg K. Syphilis and HIV co-infection. Eur J Intern Med 2009;20(1):9-13.
6. Stevenson J, Heath M. Syphilis and HIV infection: an update. Dermatol Clin 2006;24(4):497-507.
7. Domantay-Apostol GP, Handog EB, Gabriel MT. Syphilis: the international challenge of the great imitator. Dermatol Clin 2008;26(2):191-202.
8. Roberts MC, Emsley RA. Psychiatric manifestations of neurosyphilis. S Afr Med J 1992;82(5):335–7.
9. Mitsonis C, Kararizou E, Dimopoulos N, Triantafyllou N, Kapaki E, Mitro poulos P, et al. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci 2008;118(9):1251–7.
10. Loseva OK, Zalevskaya OV, Bokhonovich DV, Matynkina NV, Maksimova IV. Late neurosyphilis in a psychiatric hospital. Zh Nevrol Psikhiatr Im S S Korsakova 2018;118(10):19-24.
11. Mirsal H, Kalyoncu A, Pektaş O, Beyazyürek M. Neurosyphilis presenting as psychiatric symptoms: an unusual case report. Acta Neuropsychiatr 2007;19(4):251-3.
12. Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M. Manifest psychosis in neurosyphilis. Gen Hosp Psychiatry 2009;31(4):379-81.
13. Akıncı E, Öncü F, Topçular B. Neurosyphilis in Psychiatric Settings: Three Case Reports. Turk Psikiyatri Derg 2017;28(1):61-66.
14. Toptan T, Ozdilek B, Kenangil G, Ulker M, Domac FM. Neurosyphilis: a case report. North Clin Istanb 2015;24;2(1):66-8.
15. Wahab S, Md Rani SA, Sharis Othman S. Neurosyphilis and psychosis. Asia Pac Psychiatry 2013;5 Suppl 1:90-4.
16. Kinson RM, Chan LG. Psychiatric symptoms as the sole manifestation of neurosyphilis. J Neuropsychiatry Clin Neurosci 2013;25(4):39–40.
17. Tulachan P, Chapagain M, Sharma V. Psychiatric manifestation of neuro syphilis. J Psychiatr Assoc Nepal 2014;1(1):26–7.
18. Seo EH, Yang HJ, Kim SH, Park JH, Yoon HJ. Psychotic mania as the solitary manifestation of neurosyphilis. Ann Gen Psychiatry 2018;6;17:24.
19. Bozdemir H, Tamam L, Özeren A, Zeren M, Sarıca Y.Neurosyphilis: Report of two patients. Annals of Medical Sciences 2000;9:27-30.
20. Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, et al. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci 2019;69:67-73.
21. Acarel EE, Aslan IK, Karagöz N, Altın Ü, Örnek İ, Kırbaş D. HIV negatif nörosifiliz olgu sunumu. Demans Dergisi 2002;2:27-31.
22. Özselek S, Erdem M, Uzun Ö, Ilıca TA, Özşahin A. A neurosyphilis case presenting with dementia. Düşünen Adam:The Journal of Psychiatry and Neurological Sciences 2011;24:145-48.
23. Ropper AH. Neurosyphilis. N Engl J Med 2019;381(14):1358- 63.
24. Gonzalez H, Koralnik IJ, Marra CM. Neurosyphilis. Semin Neurol 2019;39(4):448-5.
25. Russouw HG, Roberts MC, Emsley RA, Truter R. Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis. Biol Psychiatry 1997;41(4):467–73.
26. Jeong YM, Hwang HY, Kim HS. MRI of neurosyphilis presenting as mesiotemporal abnormalities: a case report. Korean J Radiol 2009;10(3):310-2.
27. Barbosa IG, Vale TC, de Macedo DL, Gomez RS, Teixeira AL. Neurosyphilis presenting as mania. Bipolar Disord 2012;14(3):309-12.
28. Yeloğlu Ç, Hocaoğlu Ç. Önemli bir ruh sağlığı sorunu: Bipolar Bozukluk. Mustafa Kemal Üniversitesi Tıp Dergisi 2017; 41-54.
29. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA 2014; 312(18):1905-17.
30. Buitrago-Garcia D, Martí-Carvajal AJ, Jimenez A, Conterno LO, Pardo R. Antibiotic therapy for adults with neurosyphilis. Cochrane Database Syst Rev 2019; 27;5(5):CD011399.
31. Andrade C, Harshe D, Tharayil HM, Tekkalaki B. Blonanserin patch for schizophrenia. Schizophr Res 2020;215:445.
32. Iwata N, Ishigooka J, Kim WH, Yoon BH, Lin SK, Sulaiman AH, et al. Efficacy and safety of blonanserin transdermal patch in patients with schizophrenia: A 6-week randomized, double- blind, placebo-controlled, multicenter study. Schizophr Res 2020 215:408-15.
33. Sanchez FM, Zisselman MH. Treatment of psychiatric symptoms associated with neurosyphilis. Psychosomatics 2007;48(5):440–5.
34. Pecenak J, Janik P, Vaseckova B, Trebulova K. Electroconvulsive therapy treatment in a patient with neurosyphilis and psychotic disorder: Case report and literature review. J ECT 2015;31(4):268-70.
35. Yanhua W, Haishan S, Le H, Xiaomei Z, Xinru C, Ling L, et al. Clinical and neuropsychological characteristics of general paresis misdiagnosed as primary psychiatric disease. BMC Psychiatry 2016;11;16:230.
36. Crozatti LL, de Brito MH, Lopes BN, de Campos FP. Atypical behavioral and psychiatric symptoms: Neurosyphilis should always be considered. Autops Case Rep 2015;5(3):43-7.