Congenital paretic syphilis presenting as progressive myoclonic encephalopathy

Area of Science:

• Neurology
• Infectious Diseases
• Clinical Case Study

Background:

• Neurosyphilis is a late complication of Treponema pallidum infection affecting the central nervous system.
• It can manifest with a wide range of neurological and psychiatric symptoms, often mimicking other conditions.
• Early diagnosis and treatment are crucial to prevent irreversible neurological damage.

Purpose of the Study:

• To report a case of neurosyphilis in a 17-year-old male presenting with specific neurological and behavioral symptoms.
• To highlight the diagnostic challenges and key findings in this patient.
• To emphasize the importance of considering neurosyphilis in the differential diagnosis of young individuals with progressive neurological decline.

Main Methods:

• Clinical presentation review of a 17-year-old male with progressive behavioral abnormalities and neurological deficits.
• Cerebrospinal fluid (CSF) and serum Venereal Disease Research Laboratory (VDRL) testing.
• Treponema pallidum hemagglutination assay (TPHA) for maternal testing.
• Electroencephalogram (EEG) to evaluate seizure activity and myoclonic jerks.

Main Results:

• The patient exhibited progressive behavioral abnormalities, mental deterioration, unsteadiness, myoclonic jerks, and generalized tonic-clonic seizures.
• CSF and serum VDRL tests were positive, indicating active syphilis infection.
• Maternal TPHA test was also positive.
• EEG findings were consistent with myoclonic jerks.

Conclusions:

• This case underscores the varied and severe neurological manifestations of neurosyphilis, even in adolescents.
• Positive VDRL and EEG findings in conjunction with clinical symptoms are critical for diagnosis.
• Neurosyphilis should be considered in the differential diagnosis of young patients presenting with unexplained neurological and psychiatric deterioration.