Abstract
IntroductionNeurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges. Despite being an Old World disease, the rates of infection continue to rise. This clinical challenge involves early and accurate diagnosis, as neurosyphilis masquerades with various clinical symptoms and is often missed during initial presentation to the hospital. A comprehensive history and clinical examination are essential to detect suspicious cases early for further cerebrospinal fluid examination and neuroimaging. Patients treated with benzylpenicillin for a specific duration often show promising clinical and cognitive improvement, thus emphasizing the need for constant vigilance in our day-to-day practice.Case presentationA 77-year-old Caucasian gentleman presented to our hospital repeatedly with multiple episodes of presyncope and cognitive impairment. He also demonstrated bilateral deafness, tabes dorsalis, and left sixth cranial nerve palsy. His cerebrospinal fluid examination showed a nonreactive venereal disease research laboratory test, and magnetic resonance imaging of the brain revealed a gumma.ConclusionThe diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging.
Highlights
Neurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges
The diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging
Its disease is broadly categorized into four stages: the primary stage, characterized by the development of a painless ulcer known as a chancre on the genitalia; the secondary stage, often seen with disseminated disease, which predominates with cutaneous manifestations; and a late early and late latent phase, whereby obvious clinical symptoms have resolved, and laboratory investigations are key to making a diagnosis
Summary
Syphilis is a sexually transmitted disease that has been present for centuries. It is caused by the spirochete Treponema pallidum and is transmitted horizontally through sexual contact or vertically from mother to baby. The variety of clinical presentations combined with the lack of a gold standard test has made the diagnosis often challenging It has raised many controversies surrounding the utility of cerebrospinal fluid (CSF) assays for disease confirmation. Case presentation Our patient is a 77-year-old frail gentleman with type 2 diabetes mellitus on oral hypoglycemic medications who lives with his daughter, requiring support with daily living activities His past medical history is significant for hypertension, chronic kidney disease, and gout. His history is significant for bilateral hearing impairment, previously attributed to a vestibular disease and a possible past syphilis infection which remains unknown within the local STD registry. It is uncertain whether treatment was ever commenced. The CSF syphilis nucleic acid antigen (NAA) test was negative, CSF fluorescent treponemal
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