{"id":1210,"date":"2010-12-06T06:28:59","date_gmt":"2010-12-06T11:28:59","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1210"},"modified":"2015-06-04T15:24:18","modified_gmt":"2015-06-04T19:24:18","slug":"tough-diagnoses-neurosyphilis-then-and-now","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/tough-diagnoses-neurosyphilis-then-and-now\/2010\/12\/06\/","title":{"rendered":"Tough Diagnoses: Neurosyphilis, Then and Now"},"content":{"rendered":"

\"lewis_clark\"During Thanksgiving, my brother-in-law — who is a professional musician<\/a> and also a passionate history buff — gave me a scholarly paper to review on the strange death of the famous American explorer\u00a0Meriwether Lewis<\/a>, of “Lewis and Clark” fame.<\/p>\n

The bottom line? \u00a0Lewis may well have had neurosyphilis — at least that’s the premise of the epidemiologist\u00a0Reimert Thorolf Ravenholt<\/a>, who, in a nearly 13,000 word report<\/a>, ultimately concludes:<\/p>\n

The fabric of evidence that syphilis acquired during the explorative trip to the Pacific Coast was the un\u00adderlying cause of Lewis\u2019s death includes these threads: (1) Lewis was in excellent health when he set forth up the Missouri River; (2) several Indian tribes suffering from syphilis were encountered; (3) sexual intercourse with women of these tribes by Corps members was frequently urged by the Indians and was commonplace; (4) several Corps members (probably at least eight) did develop syphilis; (5) when encountering the Shoshoni tribe on the Continental Divide, Lewis had both a propitious opportunity and a compelling need for sex\u00adual intercourse; (6) a few weeks later, he developed illness which became severe and disabling for several months, but the nature of which was not described; (7) for some months in 1807, following his return from the expedition, he was incapacitated by illness, the nature of which was not divulged; (8) during 1808\u00ad-809, he developed progressive illness afflicting his central nervous system and diminishing his judgment faculties; (9) his terminal months in 1809 were char\u00adacterized by progressive, episodic, febrile illness, with severe mental and behavioral disorders highly charac\u00adteristic of paresis; (10) Lewis himself recognized that he was suffering from a progressive disease likely to be fatal; (11) Thomas Jefferson and William Clark readily understood why his death was a probable act of self\u00ad destruction.<\/p><\/blockquote>\n

Emphatically not<\/em> the Lewis and Clark story I learned in 5th Grade!<\/p>\n

But sure, the diagnosis of neurosyphilis sounds plausible. \u00a0Sexual indiscretion followed by rashes followed by a progressive neurologic disease with increasingly bizarre and unreliable behavior. \u00a0(Not so sure about the fever part.)<\/p>\n

But while these speculative diagnoses are fascinating both historically and medically (Mozart’s death<\/a> has 325 citations in PubMed), one inevitably gets back to the problem of confirming the diagnosis, which is almost always impossible.<\/p>\n

Furthermore, there are several reasons why neurosyphilis is in particular<\/em> a difficult diagnosis to prove, even today, including:<\/p>\n