The many faces of neurosyphilis: Experience in a Colombian Hospital

Abstract

Neurosyphilis, a systemic disease secondary to an infection by Treponema pallidum that affects the central nervous system at any stage of the disease, remains a diagnostic challenge for the neurologist due to its wide variety of clinical presentation, which led to the name of “the great mimicker”. Despite being in the post-penicillin era, in Colombia it persists being endemic, although its exact prevalence regarding neurological manifestations is still unknown. We present a series of 10 cases of patients hospitalized between 2017 and 2019 at the San José Hospital in Bogotá, Colombia, admitted with different neurological manifestations in whom the diagnosis of neurosyphilis is confirmed. Of the clinical presentations described in the literature were: 1 patient with asymptomatic neurosyphilis, 2 patients with syphilitic meningitis (1 with vertex involvement and 1 with basilar involvement), 5 with meningovascular syphilis and finally 2 with a general paresis type. Of the 10 patients, the 50% course with human immunodeficiency virus and presented a favorable clinical evolution after the treatment with crystalline penicillin for 14 days. We can observe that neurosifilis is still a health problem in developing countries and given its extensive neurological manifestations associated with presentation in immunocompromised and immunocompetent patients, it remains a diagnostic challenge and should be considered as a differential diagnosis in daily clinical practice.