Case Report
A Case of Creutzfeldt-Jakob Disease with Concomitant Neurosyphilis
Emma Frost*,
Melody Lee Yu,
Marina Santos De Sousa,
Karandeep Bhatti,
Omar Elmandouh,
Courtney Curran,
Pratit Patel,
Raquel Nahra,
Jesse Thon,
Olga Thon
Issue:
Volume 5, Issue 2, June 2026
Pages:
15-18
Received:
20 February 2026
Accepted:
10 March 2026
Published:
22 July 2026
DOI:
10.11648/j.ijmcr.20260502.11
Downloads:
Views:
Abstract: A 48-year-old man with a history of schizophrenia, bipolar disorder, spinal cord lipoma resection, retinal artery occlusion, alcohol use disorder, and methamphetamine use presented to the hospital after being found unresponsive at his house. On initial evaluation, he was inattentive, but oriented to self, time, and location, and was able to follow commands, speak fluently in short sentences, and had no focal deficits, aside from chronic lower extremity weakness and sensory loss related to his spinal cord lipoma. He was treated for a urinary tract infection however continued to have neurologic decline. An extensive neurological workup was conducted, which included multiple CT scans, three days of electroencephalogram (EEG), lumbar puncture and Magnetic Resonance Imaging (MRI) brain with and without contrast. Brain MRI showed diffusion weighted imaging (DWI) hyperintensities along the cortical ribbon of the temporal, parietal, and frontal lobes with intrinsic T1 hyperintense changes but no true contrast enhancement, as well as prominent medial temporal lobe DWI and T2/FLAIR hyperintensities. He was found to have a positive serum RPR at a titer of 1:64, positive serum treponemal antibody, and positive CSF VDRL at a titer of 1:8. CSF had a lymphocytic pleocytosis. Following a full course of intravenous Penicillin G 24 million units daily for 2 weeks for treatment of neurosyphilis, the patient showed signs of improvement, specifically in cognitive domains of attention and comprehension. However, one week later, his mentation worsened again. He developed agitation, mood swings, confabulation, and intermittent unresponsiveness. A second lumbar puncture revealed elevated 14-3-3 protein levels (41,897), T-Tau >20,000, and a positive RT-QuIC test, consistent with prion disease. A repeat brain MRI showed progressive cortical ribboning (figure), also consistent with a diagnosis of CJD. In practice, when faced with rapidly progressive dementia, clinicians should consider treatable etiologies such as neurosyphilis first but remain vigilant for co-pathologies if deterioration persists.
Abstract: A 48-year-old man with a history of schizophrenia, bipolar disorder, spinal cord lipoma resection, retinal artery occlusion, alcohol use disorder, and methamphetamine use presented to the hospital after being found unresponsive at his house. On initial evaluation, he was inattentive, but oriented to self, time, and location, and was able to follow ...
Show More
Case Report
Surgical Repair of Secundum Atrial Septal Defect in a Patient with Addison’s Disease and Diabetes Mellitus Type I: A Case Report
Issue:
Volume 5, Issue 2, June 2026
Pages:
19-23
Received:
3 March 2026
Accepted:
16 March 2026
Published:
22 July 2026
DOI:
10.11648/j.ijmcr.20260502.12
Downloads:
Views:
Abstract: Primary adrenal insufficiency, most commonly due to autoimmune destruction of the adrenal cortex (Addison’s disease), is a rare but life-threatening condition requiring lifelong glucocorticoid replacement. Surgical stress markedly increases cortisol demand and may precipitate adrenal crisis in inadequately covered patients. Atrial septal defect, especially the secundum type, is among the most common congenital heart defects; however, reports describing surgical atrial septal defect repair in patients with coexisting type I diabetes mellitus and Addison’s disease are lacking. The perioperative management of such patients presents unique endocrine and hemodynamic challenges. This case highlights the importance of meticulous multidisciplinary coordination to prevent adrenal crisis and optimize glycemic control during major cardiac surgery. A 22-year-old male with a history of type I diabetes mellitus (diagnosed at age 16) and Addison’s disease (diagnosed nine months prior) was incidentally found to have a large secundum atrial septal defect. Despite being asymptomatic, surgical repair was indicated following comprehensive cardiologic assessment, including right heart catheterization and balloon occlusion testing. A multidisciplinary team involving cardiology, cardiothoracic surgery, anesthesia, and endocrinology planned perioperative care. Stress-dose steroids were administered intraoperatively, and adequate glycemic control was achieved. The defect was successfully closed. Postoperatively, the patient remained hemodynamically stable without evidence of adrenal crisis. Glycemic fluctuations and reduced oral intake were managed with endocrine optimization. This case demonstrates that successful surgical atrial septal defect repair in patients with concomitant Addison’s disease and type I diabetes mellitus is achievable through proactive endocrine optimization and close interdisciplinary collaboration. Early planning, appropriate stress-dose steroid coverage, and vigilant perioperative monitoring are essential to prevent adrenal crisis and improve outcomes in complex comorbid patients undergoing major cardiac surgery.
Abstract: Primary adrenal insufficiency, most commonly due to autoimmune destruction of the adrenal cortex (Addison’s disease), is a rare but life-threatening condition requiring lifelong glucocorticoid replacement. Surgical stress markedly increases cortisol demand and may precipitate adrenal crisis in inadequately covered patients. Atrial septal defect, es...
Show More
,
Akbar Mistry
