Penicillin therapy in a case of tabes dorsalis

Abstract

In a man 78 years old, suffering from tabes dorsalis with paralysis of the inferior limbs, frequent lightning pains, severe gastric disturbances, initial urinary incontinency and a general bad condition, the disease having started more than 50 years after the first syphilitic infection, an intensive penicillin treatment was made. The drug was injected daily into the spine, during 7 days, in increasing doses from 15.000 to 82.500 Oxford units. Simultaneously there were injected intramuscularly doses which ranged from 50 to 90.000 units in 24 hours and during 10 days. The total doses given both into the spine and the muscles attained 1.110.000 units in 10 days (297.500 intrathecal and 812.500 intramuscularly). At the end of this treatment the patient suffered a strong gastric crises, which prostated him for several days, and which was followed by a vesic-prostatic crises. The possibility is here raised that these manifestations (crises) may be caused by the high alcalinization of the body due to the injections of the sodic penicillin and also to the high doses of dextrose solution given in order to counterbalance the profound state of adinamy of the patient. The improvement observed between 48 and 60 days after the treatment was started may be resumed as follows: - Climical - there were relieved about 75% of the lightning pains (frequency and intensitity) and 100% of the urinary incontinency which started some days before the treatment, disappeared all-together. The gastric disturbances disappeared and the general condition was greatly improved. There was observed a return of the cutaneous-planter reflexes and a slight reaction of the pupillary reflexes to the light, both absent before the treatment was started, Humoral - (liquor) - large improvements in the cells counting, in the globulinic reactions (Pandy, Weichbrodt) in the Takata-Ara, in the amount of albumin and in the colloidal benjoin reaction (parenchymatosous or intermediate zone.); - (blood) - a slight decrease of positivity (Wassermann and Kahn). Based on the present observation, it is suggested that one may, perhaps, increase the dosage of 20.000 daily units, into the spine, to 40 or 50.000 units, during 7-10 days, without danger to the patient and with a chance for a much better result.