-Case Reports-

Neurosyphilis Mimicking Ramsay Hunt Syndrome

Tadashi Maeda¹, Sadako Yoshizawa¹, Takehisa Hirayama³, Tomoo Saga², Kazuhiro Tateda² and Yoshihisa Urita¹

¹Department of General Medicine and Emergency Care, Toho University School of Medicine
²Department of Microbiology and Infectious Diseases, Toho University School of Medicine
³Department of Neurology, Toho University School of Medicine

A 36-year-old man presented with facial nerve palsy, hearing loss, vertigo and headache. He was initially diagnosed with Ramsay Hunt syndrome and treated with a systemic steroid and valaciclovir; however, his symptoms deteriorated. Serum rapid plasma reagin (RPR) and treponema pallidum hemagglutination tests were positive. Cerebrospinal fluid analysis revealed an elevated white blood cell count and positive RPR, confirming the diagnosis of neurosyphilis. Penicillin G (PCG) was administered, and his facial nerve function and headache improved. However, left-side hearing loss worsened temporarily, which was assumed to be a Jarisch-Herxheimer reaction. Betamethasone was administered along with PCG, and he recovered completely.

J Nippon Med Sch 2015; 82: 254-256

Keywords
neurosyphilis, Ramsay Hunt syndrome

Correspondence to
Tadashi Maeda, MD, PhD, Department of General Medicine and Emergency Care, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan
tadashi.ma@hotmail.co.jp

Received, September 25, 2014
Accepted, April 16, 2015