Nissl arteritis in meningovascular syphilis and ceftriaxone therapeutic failure. Case report and review

The authors report a case of a 45 year old patient, negative VIH,with recurrent stroke, secondary to meningovascular syphilis andtherapeutic failure with ceftriaxone. The neurosyphilis is due to impairment of the nervous central system for the Treponema pallidumin any stadium of the condition, and includes both asymptomatic andsymptomatic forms of the infection. The forms of presentation arediverse and depend of the location and extension of the lesions. TheMRI shown multiple vascular injuries which reflects the impairment ofsmall blood vessels (Nissl arteritis) caused by the Treponema .Thecurrent recommendation of the treatment is with crystalline penicillin G intravenously 4 millions every 4 hours for 14 days. The evidence up to the present time in people’s positive VIH with latent syphilis with or without neurosyphilis treated with ceftriaxone has showned up to 23% of therapeutic failures. There is a lack of information in immunocompetent patients.