31-Year-Old Woman With Chronic Daily Headache and Alopecia

    January 2013 in “ Mayo Clinic Proceedings ”
    Chad Cherington, Steven W. Ressler
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    TLDR A woman's chronic headaches and hair loss were cured by treating her syphilis.
    In 2013, a 31-year-old woman with a 7-month history of various symptoms including chronic daily headache, neck pain, fatigue, mental fogginess, weight loss, nausea, paresthesia, and alopecia was diagnosed with secondary syphilis with alopecia syphilitica, and suspected neurosyphilis despite a negative cerebrospinal fluid (CSF) VDRL test. Her symptoms, MRI findings indicating hypertrophic pachymeningitis, and laboratory results, including an elevated rapid plasma reagin (RPR) titer and lymphocytic pleocytosis in the CSF, led to this diagnosis. She was treated with penicillin G and benzathine penicillin, which resulted in the complete resolution of her headaches and cessation of hair loss. Her boyfriend also tested positive for syphilis and was treated. The case underscores the need to consider syphilis in patients with chronic meningitis symptoms and alopecia. The patient's follow-up includes CSF examinations every 6 months and monitoring serum RPR titers for a 4-fold decrease to confirm the resolution of neurosyphilis. The document also discusses syphilis stages, epidemiology, and the impact of HIV coinfection, highlighting the importance of comprehensive testing for accurate diagnosis and monitoring.
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