Initially Unrecognized Dementia in a Young Man With Neurosyphilis

Abstract

In general paresis, the invading spirochetes destruct the neurons resulting in impairments in memory, intellect, affect, and judgment of the infected patients. If neurosyphilis is diagnosed early enough, a timely effective treatment may not only prevent further progression of the disease but also allow complete recovery. We report a 35-year-old man with rapid cognitive deterioration. Neurotic depression with dementia was initially diagnosed and the patient was treated with antidepressants, with a poor response. Neurosyphilis with general paresis was diagnosed 1 year later. A 2-week course of intensive treatment with penicillin G was started. Persistent dementia and progressive brain atrophy were found 6 months later, despite an improved cerebrospinal fluid profile and cerebral blood flow indicated by serial single-photon emission computed tomography. This case underscores the importance of early diagnosis of neurosyphilis, and the clinicians should alert the possibility of neurosyphilis in patients who present with dementia.