Quetiapine vs. risperidone in treating psychosis in neurosyphilis: a case report

A 44-year-old male patient presented with agitation, auditory hallucinations, and delusions of persecution was diagnosed as having neurosyphilis.

He was treated with penicillin G 24 million units/day, risperidone 6 mg/day, and memantine 20 mg/day with partial response to psychotic symptoms and significant extrapyramidal symptoms.

On his follow-up, after 5 months, his cognitive status and serological tests remained the same, and his cell count was increased. A second therapy of penicillin was administered without any clinical improvement. On his second hospitalization for severe psychotic agitation after approximately 1 year, quetiapine 1200 mg/day was introduced and the psychiatric state improved immediately without significant side effect.

Quetiapine, which has a low potential for producing extrapyramidal side effects, should be considered in the treatment of psychotic symptoms of neurosyphilis.