A late form of neurosyphilis manifesting with psychotic symptoms in old age and good response to ceftriaxone therapy

2010 ◽  
Vol 23 (4) ◽  
pp. 666-669 ◽  
Author(s):  
Erdem Güler ◽  
Thomas Leyhe
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Old Age ◽  
Antibiotic Treatment ◽  
Affective Disorders ◽  
Elderly Woman ◽  
Psychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Personality Changes ◽  
Late Form

ABSTRACTNeurosyphilis can present with psychiatric symptoms. The late form can occur in old age with psychosis, paranoid delusions, affective disorders or cognitive impairment. Here we present a case of neurosyphilis in an elderly woman who, over six months, progressively manifested personality changes and paranoid delusions which were initially suspected as Alzheimer's disease. Psychotic symptoms showed a good response to antibiotic treatment. We conclude that neurosyphilis is a relevant differential diagnosis in patients developing severe psychiatric symptoms in old age. As a causal antibiotic treatment is possible this infectious disease should be considered seriously in gerontopsychiatric patients.

The trip of a lifetime: hallucinogen persisting perceptual disorder

2017 ◽  
Vol 26 (1) ◽  
pp. 11-12 ◽  
Author(s):  
Lauren Anderson ◽  
Hannah Lake ◽  
Mark Walterfang
Keyword(s):  
Differential Diagnosis ◽  
Affective Disorders ◽  
Occipital Lobe ◽  
Anxiety And Depression ◽  
Psychotic Symptoms ◽  
Clinical Settings ◽  
Diagnostic Challenge ◽  
Increased Risk ◽  
Occipital Lobe Epilepsy ◽  
Development Of Anxiety

Objectives: The differential diagnosis of psychotic symptoms is broad and extends beyond primary psychotic and affective disorders. We aim to illustrate that the chronology and phenomenological nature of hallucinatory symptoms may provide clues towards alternative diagnoses, such as hallucinogen persisting perceptual disorder (HPPD). We describe the resurgence of visual pseudo-hallucinations in a young woman in the context of previous substance-induced hallucinatory symptoms and a prior diagnosis of occipital lobe epilepsy. She presented a diagnostic challenge, saw several emergency and specialist doctors and attracted stigmatising diagnoses leading to anxiety and depressive symptoms. Her symptoms were finally recognised as HPPD, and she was treated appropriately with lamotrigine. Conclusions: Patients with perceptual disturbance can present in various clinical settings, and HPPD is an under-recognised diagnostic possibility. Delayed or misdiagnosis prolongs profound functional impairment and social decline, and predisposes the patient to the development of anxiety and depression and related increased risk of suicide.

Differential Diagnosis Based on Age. Diagnostic Difficulties

2016 ◽  
Vol 33 (S1) ◽  
pp. S473-S473
Author(s):  
S. Rodrígue Vargas
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Review Of The Literature ◽  
Diagnostic Difficulties ◽  
Diagnostic Hypothesis ◽  
Competing Interest

IntroductionFollowing a case presented in our inpatient unit as well as various interdepartmental from internal medicine and other emergencies, we decided to conduct a literature review on the different organic causes that can trigger the onset of psychotic symptoms in elderly.ObjectivesA correct differential diagnosis of psychiatric symptoms in elderly.AimsLiterature review of the literature on the presentation of psychotic symptoms in the elderly.MethodsDescription of a clinical case and development of diagnostic hypotheses.Results and conclusionsFor several decades are experiencing a gradual aging of the population, which means that we are at the onset of clinical symptoms not described by classical authors. Furthermore, scientific advances make infectious causes (such as neurosyphilis was our first diagnostic hypothesis) are increasingly rare. The elderly usually has multiple comorbidities, which are receiving various treatments that must be ruled out possible adverse effects.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Delusions and Hallucinations as First Symptoms of Frontotemporal Dementia: A Case Report of a 48-Year Old Male

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Malta ◽  
C. Torres ◽  
T. Faria ◽  
S. Almeida
Keyword(s):  
Differential Diagnosis ◽  
Frontotemporal Dementia ◽  
Frontotemporal Lobar Degeneration ◽  
Psychotic Disorders ◽  
Functional Neuroimaging ◽  
Neuropsychiatric Symptoms ◽  
Psychotic Symptoms ◽  
Psychiatric Ward ◽  
Personality Changes ◽  
Behavior Impairment

Frontotemporal dementia (FTD) generally has a presenile onset, behavioral manifestations dominate the clinical picture during which cognitive functions are still relatively intact. Therefore, particularly in the early stages of FTD it is difficult to differentiate this type of dementia from other types of dementia and psychiatric disorders.Although most patients with frontotemporal dementia (FTD) present with neuropsychiatric symptoms, the frequency of psychotic symptoms, assumed to be rare, is still unclear possibly due to limited temporal-limbic involvement in this disorder. We report the case of a 48-year old man admitted in a psychiatric ward with delusions and hallucinations.Significant behavior impairment was present related to social isolation and personality changes. Structural and functional neuroimaging methods disclosed asymmetric frontal and bitemporal damage, mainly on the left. Differential diagnosis consisted of psychotic disorders as well as one of the subtypes of the frontotemporal lobar degeneration group.

Recent Advances in the Synthesis and Development of Nitroaromatics as Anti-Infective Drugs

2020 ◽  
Vol 26 (36) ◽  
pp. 4658-4674 ◽  
Author(s):  
Christina Kannigadu ◽  
David. D. N'Da
Keyword(s):  
Infectious Disease ◽  
Drug Resistance ◽  
Chest Pain ◽  
Muscle Pain ◽  
New Drugs ◽  
Lymph Glands ◽  
Recent Advances ◽  
Personality Changes ◽  
Clinical Drugs ◽  
Antiparasitic Agents

: Infectious diseases commonly occur in tropical and sub-tropical countries. The pathogens of such diseases are able to multiply in human hosts, warranting their continual survival. Infections that are commonplace include malaria, chagas, trypanosomiasis, giardiasis, amoebiasis, toxoplasmosis and leishmaniasis. Malaria is known to cause symptoms, such as high fever, chills, nausea and vomiting, whereas chagas disease causes enlarged lymph glands, muscle pain, swelling and chest pain. People suffering from African trypanosomiasis may experience severe headaches, irritability, extreme fatigue and swollen lymph nodes. As an infectious disease progresses, the human host may also experience personality changes and neurologic problems. If left untreated, most of these diseases can lead to death. : Parasites, microbes and bacteria are increasingly adapting and generating strains that are resistant to current clinical drugs. Drug resistance creates an urgency for the development of new drugs to treat these infections. Nitro containing drugs, such as chloramphenicol, metronidazole, tinidazole and secnidazole had been banned for use as antiparasitic agents due to their toxicity. However, recent discoveries of nitrocontaining anti-tuberculosis drugs, i.e. delamanid and pretonamid, and the repurposing of flexinidazole for use in combination with eflornithine for the treatment of human trypanosomiasis, have ignited interest in nitroaromatic scaffolds as viable sources of potential anti-infective agents. : This review highlights the differences between old and new nitration methodologies. It furthermore offers insights into recent advances in the development of nitroaromatics as anti-infective drugs.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

scholarly journals An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients – a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabriela M. Wiedemann ◽  
Jochen Schneider ◽  
Mareike Verbeek ◽  
Björn Konukiewitz ◽  
Christoph D. Spinner ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Differential Diagnosis ◽  
Antibiotic Treatment ◽  
Partial Remission ◽  
Combined Treatment ◽  
Lymphocytic Leukemia ◽  
Entire Body ◽  
Tropical Diseases ◽  
Ecthyma Gangrenosum ◽  
Skin Ulcers

Abstract Background Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG. Case presentation A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3–4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins. Conclusions In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.

Fahr’s disease with an initial presentation of crescendo TIA

2021 ◽  
Vol 14 (6) ◽  
pp. e242837
Author(s):  
Paul Smith ◽  
Kalun Ng ◽  
Kailash Krishnan
Keyword(s):  
White Matter ◽  
Psychiatric Symptoms ◽  
Symptomatic Relief ◽  
Management Strategies ◽  
Initial Presentation ◽  
Fahr’S Disease ◽  
Fahr's Disease ◽  
Personality Changes ◽  
Brain Calcification ◽  
Ischaemic Attack

A 51-year-old man presented with vertigo, slurred speech and left facial droop. He had been previously diagnosed with transient ischaemic attack (TIA) and had a prior lacunar infarct. Imaging showed heavy symmetrical calcification in the globus pallidus, frontal white matter and cerebellar dentate nuclei/deep white matter. The imaging was pathognomonic for Fahr’s disease and diagnosis was confirmed when other secondary causes of hypercalcemia were excluded. Fahr’s disease is a rare, autosomal dominant, neurological condition characterised by primary brain calcification. Patients present with progressive neurological and psychiatric symptoms; commonly, Parkinsonian movement disorders, seizures, headaches, dysarthria, cognitive decline, psychosis and personality changes. There is an association with intracerebral ischaemic events. This case supports a growing body of anecdotal evidence of this association and is the first in which crescendo TIA may be the initial presentation of Fahr’s disease. Referral for genetic counselling and symptomatic relief for neurological symptoms are the main management strategies.

The Diagnostic Validity of Paraphrenia

1992 ◽  
Vol 26 (1) ◽  
pp. 18-29 ◽  
Author(s):  
Anne M. Hassett ◽  
Nicholas A. Keks ◽  
Henry J. Jackson ◽  
David L. Copolov
Keyword(s):  
Old Age ◽  
Classification Systems ◽  
Historical Background ◽  
Psychotic Symptoms ◽  
Clinical Parameters ◽  
Diagnostic Validity ◽  
Separate Entity ◽  
Distinct Entity ◽  
Icd 10

It remains a matter of conjecture as to whether a schizophrenia-like syndrome commencing in old age differs from the early-onset disorder in any substantial way. This article reviews both the historical background to the concept of defining paraphrenia as a distinct entity, as well as the current controversies concerning whether it should remain a separate entity: the latter is important as paraphrenia has not been included in the DSM Ill-R and ICD 10 classification systems. Clinical parameters and aetiological factors relevant to an understanding of the syndrome are discussed under the rubrics of descriptive and construct validity. Of particular importance are the role of cerebral organic factors and the pathoplastic effect of the ageing process and how both interface with the development of psychotic symptoms. Whilst the course of this syndrome has been considered relatively benign, outcome studies have yet to establish consistent features that provide a basis to determine predictive validity.

Cocaine Dependence Produce Psychiatric Symptoms - a Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Stankovic ◽  
S. Vucetic-Arsic ◽  
S. Alcaz ◽  
J. Cvejic
Keyword(s):  
Clinical Features ◽  
Male Patient ◽  
Psychiatric Symptoms ◽  
Cocaine Dependence ◽  
Psychotic Symptoms ◽  
Personal Contact ◽  
Outpatient Unit ◽  
Special Hospital ◽  
First Time ◽  
The Brain

Aim:We want to present a polymorphic clinical features like: hallutinations, paranoid ideas, agitation and violence as a result of prolonged cocaine intranasal consumption.Methods:We exposed a 30-year old male patient with ICD-X diagnostic criteria for cocaine dependence (intranasal consumption) that treated in the outpatient unit of Special Hospital of Addicitons, Belgrade, Serbia from April to July 2008. We used the medical records, psychical examination, psychiatric interwievs, standard blood sampling and cocaine urine detections sample (positive).Results:Observations a specific and polymorphic clinical features with presence of psychotic symptoms after cocaine consumptions in our male patient, for the first time after 5 years of cocaine dependence: auditory hallucinations (two- voice speakers), paranoid persecution ideas and suspiciousness, agitation with appearance of vegetative symptomatology (palpitations, sweating, pupil dilatation), extremely violence behavior to other people, complete social reductions (“armed to the outside world”, refused any personal contact and isolated from friends and family, permanent outdoor checking). There was an intensive fear too and impaired judgment.Conclusions:Permanent cocaine consumption can result with produce a numerous of psychiatric symptoms and syndromes as our experience does. It is similar to the findings of other studies and papers reviewed. It is suppose that cocaine has numerous effects on important neurotransmitters in the brain, such as increase as well as the release of dopamine and it related with aggressiveness, hallucinations and other psychiatric symptoms.

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