Reversible Dementia with Myoclonus Due to Concurrent HSV-2 and Syphilis Central Nervous System Infection in an Immunocompetent Man. (P5.230)

OBJECTIVE: Describe a case of progressive but reversible dementia, dysarthria, and myoclonus due to concurrent HSV-2 and syphilis central nervous system (CNS) infection in an immunocompetent man. BACKGROUND: Common conditions presenting with dementia and myoclonus include Creutzfeld Jakob disease, Cortical Basal Syndrome, Lewy Body dementia, Alzheimer’s disease, and Hashimoto’s encephalitis. Syphilis and HIV-1 infection may also cause dementia; however, but not typically dementia with myoclonus. DESIGN/METHODS: Case report. RESULTS: A 40-year-old male presented for evaluation of 2-months of progressive dysarthria and myoclonus in the context of a one year progressive dementia. Examination was remarkable for Montreal Cognitive Assessment (MoCA) of 13/30, speech latency, dysarthria, and myoclonus. A comprehensive metabolic evaluation, inflammatory markers, and HIV-1 serology were unrevealing except for a positive RPR, confirmed by FTA-ABS. An enhanced brain MRI demonstrated moderate generalized volume loss. Initial cerebrospinal fluid (CSF) analysis demonstrated a lymphocytic pleocytosis, negative CSF VDRL and positive HSV-2 PCR, but repeated CSF revealed positive VDRL and FTA-ABS. Other infectious and inflammatory CSF studies were unremarkable. The patient was treated with intravenous acyclovir for 21 days and penicillin G for 14 days. After therapy repeat CSF HSV-2 PCR was negative. Myoclonus, dysarthria, and cognitive function all improved with the MoCA score increasing to 21/30 at discharge. CONCLUSIONS: CNS co-infection of HSV-2 and syphilis is rare. Syphilis is an important cause of chronic meningitis, particularly in immunocompromised patients. HSV-2 is frequently associated with self-limited recurrent meningitis rather than chronic meningitis, with the majority of HSV-2 meningitis cases following a benign course. Here we report a reversible, infectious cause of dementia, dysarthria, and myoclonus due to chronic meningitis resulting from o co-infection with HSV-2 and T. pallidum in an immunocompetent patient. Study Supported by: Disclosure: Dr. Robles has nothing to disclose. Dr. Anand has nothing to disclose. Dr. Kass has nothing to disclose.