Neurosyphilis: Old Disease, New Implications for Emergency Physicians

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Neurosyphilis incidence is increasing, particularly in specific risk groups.
• Coinfection with human immunodeficiency virus (HIV) is common in affected populations.

Observation:

• A case study of a 27-year-old previously-healthy trans woman with progressive ascending weakness and cranial nerve VI palsy.
• The patient presented for a second time with worsening neurological deficits.

Findings:

• Early neurosyphilis was diagnosed concurrently with a new HIV diagnosis.
• The patient's symptoms included ascending weakness and cranial nerve VI palsy.

Implications:

• Emergency physicians must consider neurosyphilis in patients with new neurologic deficits, especially those in at-risk groups.
• Early diagnosis and treatment are crucial for managing this potentially severe condition.
• This case underscores the importance of screening for both syphilis and HIV in patients presenting with unexplained neurological symptoms.