Neurosyphilis in a suspected case of giant cell arteritis

2021 ◽  
Vol 14 (9) ◽  
pp. e242733
Author(s):  
Annalisa Montebello ◽  
Daniela Harmsworth ◽  
Paul John Cassar ◽  
Sandro Vella
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Venereal Disease ◽  
High Dose ◽  
Suspected Case ◽  
Venereal Disease Research Laboratory ◽  
Disease Research ◽  
History Of ◽  
Visual Blurring ◽  
Syphilis Serology

A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.

scholarly journals Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis

2018 ◽  
pp. bcr-2018-225304
Author(s):  
Gesine Boisch ◽  
Sven Duda ◽  
Christian Hartmann ◽  
Heinrich Weßling
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Arteritis ◽  
Brain Mri ◽  
Neurological Deficits ◽  
High Dose ◽  
Immunoglobulin G4 ◽  
Perifocal Oedema ◽  
History Of ◽  
Dose Corticosteroid

We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.

Progressive and Fatal Brainstem Stroke in Systemic Giant Cell Arteritis

2021 ◽  
pp. 10.1212/CPJ.0000000000001083
Author(s):  
Valentina Poretto ◽  
Silvio Piffer ◽  
Valeria Bignamini ◽  
Enzo Tranquillini ◽  
Davide Donner ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Facial Artery ◽  
High Dose ◽  
Temporal Artery Biopsy ◽  
Halo Sign ◽  
Pet Ct ◽  
Brainstem Stroke ◽  
History Of

A 74-year-old woman presented with acute worsening of six-months long history of vertigo and postural instability, with MRI evidence of cerebellar and brainstem acute infarcts. Extensive neurovascular assessment revealed a severe vascular damage with multiple stenoses and occlusions along vertebrobasilar axis (figure 1). Duplex ultrasonography showed hypoechoic halo sign along facial artery, while PET-CT highlighted increased [18F]-FDG uptake along vertebral and other larger arteries, thus allowing a diagnosis of giant cell arteritis (figure 2).1,2 Despite prompt treatment with high-dose steroids and tocilizumab, which probably made uninformative a subsequent temporal artery biopsy (figure 2), patient died of reported disability after strokes.

Normal inflammatory markers in giant cell arteritis with long-standing cranial and symptomatic large-vessel involvement

2021 ◽  
Vol 14 (6) ◽  
pp. e242602
Author(s):  
Alicia Rodriguez-Pla ◽  
Sailendra G Naidu ◽  
Yasmeen M Butt ◽  
Victor J Davila
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Inflammatory Markers ◽  
Care Physician ◽  
Large Vessel ◽  
High Dose ◽  
Surgical Revascularisation ◽  
History Of ◽  
Surgery Department ◽  
Vessel Involvement

We report the case of a 78-year-old woman who presented with cardiovascular risk factors and a history of an atypical transient ischaemic attack. She was referred by her primary care physician to the vascular surgery department at our institution for evaluation of progressive weakness, fatigue, arm claudication and difficulty assessing the blood pressure in her right arm. She was being considered for surgical revascularisation, but a careful history and review of her imaging studies raised suspicion for vasculitis, despite her normal inflammatory markers. She was eventually diagnosed with biopsy-proven giant cell arteritis with diffuse large-vessel involvement. Her symptoms improved with high-dose glucocorticoids.

scholarly journals False-positive reactions in the rapid plasma reagin-card, fluorescent treponemal antibody-absorbed, and hemagglutination treponemal syphilis serology tests

1979 ◽  
Vol 9 (3) ◽  
pp. 369-372
Author(s):  
C R Peter ◽  
M A Thompson ◽  
D L Wilson
Keyword(s):  
False Positive ◽  
Research Laboratory ◽  
Venereal Disease ◽  
Venereal Disease Research Laboratory ◽  
Rapid Plasma Reagin ◽  
Disease Research ◽  
False Positive Reactions ◽  
Normal Individuals ◽  
Syphilis Serology ◽  
Card Test

Sera from 628 nonsyphilitic individuals were tested with the Rapid Plasma Reagin-Card, Fluorescent Treponemal Antibody-Absorbed, and Hemagglutination Treponemal Test for Syphilis tests to ascertain the comparative specificity of these tests. Many sera were also tested with the quantitative Venereal Disease Research Laboratory test. Sera included in the study were from both normal individuals and patients with a variety of illnesses and conditions. The Hemagglutination Treponemal Test for Syphilis gave the lowest overall percentage of false-positive reactions (1.6%), followed by the Fluorescent Treponemal Antibody-Absorbed test (3.3%) and the Rapid Plasma Reagin-Card test (10.8%).

scholarly journals Evaluation of reagin screen, a new serological test for syphilis

1976 ◽  
Vol 4 (2) ◽  
pp. 145-150
Author(s):  
J D Dyckman ◽  
R D Wende ◽  
D Gantenbein ◽  
R P Williams
Keyword(s):  
Research Laboratory ◽  
Serological Test ◽  
Venereal Disease ◽  
The Other ◽  
Screening Tests ◽  
Venereal Disease Research Laboratory ◽  
Rapid Plasma Reagin ◽  
Disease Research ◽  
Antibody Absorption

A total of 1,020 serum and plasma specimens were tested using the Venereal Disease Research Laboratory (VDRL), Rapid Plasma Reagin (RPR) card, Reagin Screen (RST) and Fluorescent Treponemal Antibody-Absorption (FTA-ABS) tests. In 257 normal patients, all screening tests were nonreactive; the FTA-ABS test was reactive for one patient. In 588 patients with treated and untreated syphilis, the RST results were 91.7% in agreement with the VDRL and RPR results. In 175 patients with diseases that cause biological false reactions, the RST was 94% in agreement with the other screening tests. The titer of the RST was within one dilution of the corresponding VDRL titer in 91.7% of the 360 speciments tested and within one dilution of the RPR titer in 96.9% of 358 specimens quantitated by both tests.

THU0309 UNILATERAL TEMPORAL ARTERY BIOPSY IS SUFFICIENT FOR DIAGNOSING GIANT CELL ARTERITIS IF THE SERUM C-REACTIVE PROTEIN LEVEL IS 10 MG/DL OR HIGHER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 383-384
Author(s):  
T. Kise ◽  
E. Takamasu ◽  
Y. Miyoshi ◽  
N. Yokogawa ◽  
K. Shimada
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
High Dose ◽  
Temporal Artery Biopsy ◽  
C Reactive Protein ◽  
Positive Group ◽  
Reactive Protein ◽  
Discordance Rate ◽  
Serum Crp

Background:Temporal artery biopsy (TAB) is the gold standard for diagnosing giant cell arteritis (GCA). However, previous studies have reported that the discordance rate of TAB is 3-45%,i.e., in unliteral TAB, GCA may be overlooked in one in five patients, approximately. Evidence as to whether bilateral TAB should be performed initially or one-sided TAB is sufficient for diagnosing GCA is lacking.Objectives:To investigate the predictors of patients with GCA in whom one-sided TAB is sufficient.Methods:The present study was a cross-sectional, single center study conducted from April 1, 2011 to July 31, 2019 at Tokyo Metropolitan Tama Medical Center. Of all consecutive GCA cases for which bilateral TAB was performed, bilaterally positive cases and unilaterally positive cases were extracted as bilateral positive group (BPG) and unilateral positive group (UPG), respectively. GCA was defined in accordance with the classification criteria of the 1990 American College of Rheumatology, and GCA was diagnosed if no other etiology was found within six months after beginning of high-dose glucocorticoid treatment. Demographic, clinical and laboratory data were obtained from the medical records, and the BPG and the UPG were compared statistically in each variable. Statistical significance was defined asp< 0.05.Results:During study, 264 biopsies were performed for 145 cases, who suspected GCA and underwent TAB. The pathological positivity rate was 26.1% (68 / 264 biopsies). Of these, 53 cases had final diagnosis of GCA, in which 43 cases were biopsy proven GCA. Thirty-seven biopsy proven GCA with bilateral TAB were enrolled; 64.9% women; mean (SD) age 75 (8.9) years; median [IQR] TAB length 17.5 [13.0,20.0] mm; headache 54.1%; jaw claudication 45.9%; scalp tenderness 16.2%; temporal artery (TA) tenderness 32.4%; TA engorgement 32.4%; TA pulse abnormality 5.4%; visual symptoms 2.7%; a fever of 38.5°C or higher 40.5%; shoulder girdle pain 48.6%; imaging of aortitis or arteritis 40.5%; median [IQR] white blood cell 9,100 [7200, 12050] /μl; median [IQR] platelet cell 37.5 [27.0, 46.3] ×104/μl; median [IQR] C-reactive protein (CRP) 10.1 [3.9, 16.5] mg/dL; erythrocyte sedimentation rate [IQR] 105 [66, 129] mm/h. Thirty-one in 37 cases were positive bilaterally while 6 in 37 cases were positive unilaterally; and the discordance rate was 16.2%. The median sample length after formalin fixation was 19.0 mm for the BPG and 14.5 mm for the UPG (p= 0.171). The parameters above were compared between UPG and BPG. Of these, only the serum CRP value (mg/dL) differed statistically between groups, and the median value of the two groups was 10.6 and 6.5, respectively (median test:p= 0.031). To predict BPG, in whom unilateral TAB is sufficient for diagnosing GCA, the cut-off value of serum CRP with a specificity of 100% and a sensitivity of 61.3% was set at 9.3 mg/dL (ROC analysis: AUC 0.726).Conclusion:When the serum CRP level is 10 mg/dL or higher in GCA suspected patients, an unilateral TAB alone was sufficient for an accurate diagnosis.References:[1]Hellmich, B, et al.Ann Rheum Dis2020;79(1):19-30.[2]Breuer, GS, et al.J Rheumatol. 2009;36(4):794-796.[3]Czyz CN, et al.Vascular2019;27(4):347-351.[4]Durling B, et al.Can J Ophthalmol2014;49(2):157-161.Figure.Comparison of median CRP levels between unilaterally positive group and bilaterally positive group.Disclosure of Interests:None declared

Distribuição temporal de demanda e de positividade de sorologia para sífilis em laboratório de referência em Niterói, 13 anos de análise, 2006‒2018

2020 ◽  
Author(s):  
Stephanie Izidoro Barçante
Keyword(s):  
Rio De Janeiro ◽  
Research Laboratory ◽  
Venereal Disease ◽  
Venereal Disease Research Laboratory ◽  
Disease Research

Introdução: Apesar do avanço da medicina e de que nenhum caso de resistência à penicilina tenha sido publicado, a sífilis continua sendo um sério problema de saúde pública no Brasil, especialmente a sífilis congênita. Objetivo: Analisar a distribuição temporal de demanda e positividade de testes não treponêmicos VDRL (Venereal Disease Research Laboratory) realizados no Laboratório Central de Saúde Pública Miguelote Viana. Material e Métodos: Trata-se de um estudo retrospectivo de série temporal. Os objetos de análise foram: demanda de exames, positividade e dias trabalhados. Este levantamento corresponde ao período de 2006 a 2018 (12 anos), e foi realizado no Laboratório Central de Saúde Pública Miguelote Viana, em Niterói, Rio de Janeiro. Ressalta-se que os pacientes envolvidos nos exames não foram identificados. A análise de dados foi feita em parceria com o Setor de Doenças Sexualmente Transmissíveis (DST) da Universidade Federal Fluminense. Resultado e Conclusões: De janeiro de 2006 a dezembro de 2012, foram registrados 30.700 testes VDRL: em 2006, 5.235 (17,05%); em 2007, 4.622 (15,06%); em 2008, 4.620 (15,05%); em 2009, 4.415 (14,38%); em 2010, 4.024 (13,11%); em 2011, 4.079 (13,29%); e em 2012, 3.705 (12,07%). Os dias trabalhados por mês, em médias anuais, foram: 19,67 em 2006; 19,92 em 2007; 19,08 em 2008; 20,67 em 2009; 19,75 em 2010; 19,92 em 2011; e 19,75 em 2012. A média mensal de dias trabalhados foi: 20,86 em janeiro; 17,00 em fevereiro; 21,29 em março; 17,71 em abril; 20,86 em maio; 19,00 em junho; 21,86 em julho; 23,00 em agosto; 20,71 em setembro; 20,43 em outubro; 17,29 em novembro; e 17,86 em dezembro. A positividade anual foi: 4,55% em 2006; 5,26% em 2007; 5,61% em 2008; 4,94% em 2009; 5,22% em 2010; 4,98% em 2011; e 5,18% em 2012. A positividade mensal foi: 4,90% em janeiro; 5,60% em fevereiro; 5,63% em março; 4,51% em abril; 5,44% em maio; 5,08% em junho; 4,20% em julho; 4,97% em agosto; 4,34% em setembro; 5,25% em outubro; 5,58% em novembro; e 6,00% em dezembro. De julho a dezembro de 2013, foram realizados 1.786 testes VDRL: 249 em julho; 379 em agosto; 344 em setembro; 363 em outubro; 255 em novembro; e 196 em dezembro. Nesse período, 150 testes tiveram resultado positivo e a positividade foi de 8,39%. No total, foram 122 dias trabalhados, distribuídos da seguinte forma: 22 dias em julho, 22 em agosto, 21 em setembro, 22 em outubro, 17 em novembro e 18 em dezembro. O feriado de Carnaval ocorreu em: 28 de fevereiro (2006); 20 de fevereiro (2007); 05 de fevereiro (2008); 24 de fevereiro (2009); 16 de fevereiro (2010); 08 de março (2011); e 21 de fevereiro (2012). Dados dos demais anos não foram levantados, pois a instituição entrou em processo de obra. Não houve relação de sazonalidade com a demanda e com a positividade dos testes VDRL realizados no Laboratório Central de Saúde Pública Miguelote Viana. Não houve aumento na demanda de testes VDRL e/ou de positividade para o teste VDRL após o Carnaval no Laboratório Central de Saúde Pública Miguelote Viana, em Niterói.

Bilateral Carotid Siphon Involvement in Giant Cell Arteritis

Neurosurgery ◽  
1986 ◽  
Vol 18 (6) ◽  
pp. 773-776 ◽  
Author(s):  
Frederick M. Vincent ◽  
Tish Vincent
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
High Dose ◽  
Ischemic Optic Neuropathy ◽  
Vascular Changes ◽  
Bilateral Carotid ◽  
Internal Carotid Arteries ◽  
Bilateral Carotid Artery

Abstract A 60-year-old woman with inadequately treated giant cell arteritis developed an acute unilateral ischemic optic neuropathy associated with bilateral carotid artery and orbital bruits. Angiography demonstrated vascular changes compatible with arteritis localized to the cavernous and petrous segments of both internal carotid arteries. After treatment with high dose steroids, the bruits disappeared.

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