Naslov
Acute hypophysitis with hypopituitarism in an HIV- infected patient with syphilis - a case report

Autori
Marinković, Luka ; Romih Pintar, Vanja ; Zekan, Šime ; Begovac, Josip

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
CROCMID 2022: Abstract book / - , 2022, 212-212

Skup
13th Croatian congress of clinical microbiology and 10th Croatian congress of infectious diseases with international participation

Mjesto i datum
Šibenik, Hrvatska, 20.10.2022. - 23.10.2022

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
HIV, syphilis, neurosyphilis, hypophysitis, hypopituitarism.

Sažetak
BACKGROUND: Syphilis and other sexually transmitted diseases have increased in the last decade, especially among men who have sex with a man. In HIV- coinfected patients, syphilis may take a more aggressive course with neurological involvement. CASE PRESENTATION: A 28-year-old HIV- positive patient was referred to our HIV clinic for suspected meningitis. Two weeks before admission, the patient complained of progressive headache, without photophobia and phonophobia. He had fever up to 38˚C and complained of fatigue, general weakness, and loss of appetite. No visual or auditory disturbances were noted, and the neurologic exam showed no abnormalities. A head computed tomography scan was normal. Laboratory tests revealed a sodium serum level of 125 mmol/L, C- reactive protein 68.3 mg/L, thyroid-stimulating hormone 0.285 miU/L, adrenocorticotropic hormone 0.66 pmol/L, luteinizing hormone 1.6 IU/L. Cerebrospinal fluid (CSF) examination revealed mononuclear pleocytosis (35 cells/mm3) with a protein level of 1.56 g/L. Brain magnetic resonance imaging (MRI) revealed demyelinating subcortical lesions and a hypertrophic pituitary gland, which was suspected of a pituitary adenoma. Syphilis serology was performed, Treponema pallidum hemagglutination (TPHA) titers in serum were > 39 960, and the Rapid Plasma Reagin (RPR) was 64. The CSF TPHA was reactive 320, RPR was negative. He was treated with levothyroxine, hydrocortisone substitution, and empiric antibiotic treatment with ceftriaxone, ampicillin, and acyclovir, followed by crystalline penicillin for 10 days. All symptoms resolved after treatment. Syphilis serology on follow-up showed a good response to treatment, (RPR 16). A follow-up MRI of the sella turcica performed 3 months later was normal. CONCLUSION: We report a rare case of an HIV- positive patient with acute hypophysitis and hypopituitarism due to Treponema pallidum infection. Antimicrobial treatment, levothyroxine, and hydrocortisone replacement therapy resulted in resolution of all symptoms. Patients presenting with symptoms of hypopituitarism should be suspected to have hypophysitis caused by Treponema pallidum.

Izvorni jezik
Engleski

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