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March 1987

Cerebrospinal Fluid IgG Changes in Neurosyphilis After High-Dose Penicillin G Treatment

Arch Neurol. 1987;44(3):249. doi:10.1001/archneur.1987.00520150005003

To the Editor.  —We read with interest the report by Bayne et al1 concerning acute syphilitic meningitis and its occurrence after clinical and serologic cure of secondary syphilis with penicillin G benzathine therapy. We want to point attention to the cerebrospinal fluid (CSF) examination showing the feature of intrathecal IgG synthesis as ascertained by increased IgG fractions and oligoclonal bands. Intrathecal IgG synthesis is a well-known phenomenon in neurosyphilis, as well as in other infectious diseases of the central nervous system (CNS); oligoclonal bands in neurosyphilis contain specific antibodies against Treponema pallidum antigens.2 Unfortunately, in the article by Bayne et al, the CSF examinations following highdose intravenous penicillin G sodium treatment did not include the electrophoretic separation of IgG, so that it is not possible to know if oligoclonal bands were still present. There are few reports about the effect of penicillin therapy on the CSF IgG pattern