EACS2023: 1078 Neurosyphilis with multiple cranial neuropathy revealing HIV infection M. Gonçalves , J.H. Pinho , S. Reigada , E. Rabadão , C. Ventura , M. Prata , R. Gonçalves , C. Valente Coimbra Hospital and University Centre, Infectious Diseases, Coimbra, Portugal, Coimbra Hospital and University Centre, Neuroradiology, Coimbra, Portugal Title Clinical case title: Neurosyphilis with multiple cranial neuropathy revealing HIV infection Clinical case body Text: Introduction: Neurosyphilis can present as initial manifestation of HIV infection, consisting in an direct invasion of central nervous system by the spirochete Treponema pallidum. Methods: We report a case of neurosyphilis presenting with multiple cranial neuropathies. Results: A 29-year-old man presented with right peripheral facial palsy starting that morning, with 1-month history of progressive bilateral hearing loss, headache and gait imbalance. Neurological examination revealed right facial palsy with positive Bell’s phenomenon, bilateral neurosensorial hearing loss and bilaterally abolished gag reflex. Laboratory tests and CSF analysis allowed HIV infection and neurosyphilis diagnosis: serum treponemal and non-treponemal tests: positive; CSF nontreponemal test positive, HIV-1 viral load 224 000 copies/mL (5.35 log copies/ml) and CD4+ cell count 176 cells/mm3. Intravenous benzylpenicillin and HAART was started right away. On brain magnetic resonance imaging (figure 1), he was found to have bilateral enhancement of the cisternal and canalicular portions of the acoustic facial bundles, anomalous enhancement of the ninth left cranial nerve, sulcal enhancement at the right internal occipital level, possibly syphilitic gumma and vasogenic edema, presumably due to syphilitic meningoencephalitis. Discussion: It is essential to understand the significance of neurosyphilis as a considerable illness characterized by intricate neurological symptoms, involving the basal meninges and cranial nerves. When HIV is also present, the central nervous system (CNS) is affected earlier and more severely. Prompt identification and management of neurosyphilis play a critical role because neglecting it could lead to enduring disabilities that are otherwise easily treatable or preventable.. Figure 1. General conditions 1. I confirm that I previewed this clinical case and that all information is correct. I accept that the content of this clinical case cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of this clinical case constitutes the consent to publication (e.g. conference website, programmes, other promotions, etc.).: Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the clinical case. The corresponding author is responsible for informing the other authors about the status of the clinical case.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with theprivacy policy to provide the services described.: Yes 1 1 2 1 1 1 1 1 1 2 856 19TH EUROPEAN AIDS CONFERENCE | WARSAW 2023
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