Neurosyphilis presenting as parkinsonism.

Area of Science:

• Neurology
• Infectious Diseases
• Medical Diagnostics

Background:

• Neurosyphilis remains a concern, particularly in specific populations, despite advances in antibiotics.
• Parkinsonism is a clinical syndrome characterized by tremors, rigidity, and bradykinesia, often associated with idiopathic Parkinson's disease.

Observation:

• A 53-year-old male presented with parkinsonian symptoms mimicking idiopathic Parkinson's disease.
• The patient exhibited positive treponemal serology and a reactive Venereal Disease Research Laboratory (VRDL) test in his cerebrospinal fluid.

Findings:

• Neurosyphilis presenting as parkinsonism was observed, a presentation not previously documented in the postantibiotic era.
• Antibiotic therapy led to significant improvement in the patient's parkinsonian symptoms.
• A subsequent 15-year deterioration mirrored idiopathic Parkinson's disease, confirmed by dopaminergic deficit on (123I)FP-CIT SPECT imaging.

Implications:

• This case highlights the importance of syphilis screening in patients with unexplained parkinsonism, even with atypical neurosyphilitic features.
• The patient's late-stage deterioration suggests neurosyphilis may prime or accelerate the development of idiopathic-like Parkinson's disease.
• Further research is warranted to understand the long-term neurological impact of treated and untreated neurosyphilis on basal ganglia function.