HH PMR Program Director Honor Health Phoenix, Arizona, United States
Case Diagnosis: Sub-Acute Syphilitic Encephalitis
Case Description: 37-year-old male with a PMHx of PTSD, previously independent with a graduate level education was admitted for sub-acute onset psychosis to psychiatry service following 6 months of progressive behavior changes to include impulse purchases, auditory hallucinations, and delusions of grandeur. Workup with MRI revealed bitemporal and frontal cerebral edema, ventriculomegaly, and notable cerebral volume loss. Lab work was positive for serum RPR. Following antibiotic treatment he was discharged home with persistent cognitive deficits and an antipsychotic. Patient referred to PMR by ID after discussion with neurologist for ongoing cognitive deficits including short term memory loss, executive function, dysarthria, and ongoing use of antipsychotic.
Discussions: Syphilitic Encephalitis is a rare neurologic condition that typically presents most often during the secondary phase of infection with treponema pallidum. Its presentation is widely varied and often misdiagnosed. In this case, after treatment, the patient was discharged without follow-up addressing quality of life or cognitive dysfunction. He now requires 24 hour supervision and prior to infection was independent with iADL. Patient and parents were unclear of next steps to assist this 37-year-old to return to functional independent living.
Conclusions: This is the first reported case of syphilitic encephalitis referred to PM&R for rehabilitation. Objective parenchymal degeneration indicate that this patient will require long term rehabilitation and will benefit from outpatient monitoring with a physiatrist. Many cases of acute encephalitis may benefit from early referral to PM&R especially in the setting of persistent cognitive, behavioral, and functional deficits to achieve maximal functional recovery and return to the community. Neurorehabilitation or brain injury specialists have expertise in evaluating the necessity of neuromodulating medications, and leading care involving necessary consultants for cognitive dysfunction. It is helpful to partner within institutions with other medical specialties to raise awareness of the value of a neurophysiatry.
