Neurosyphilis: A Monkey Among Men

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous systemat any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called "The Great Pretender" or "Themonkey among diseases"(Krämer et al., 2018).12 This is a case report of an 83-year-old female with a history of multiple TIAs, dementia, and breast cancer who presented to the emergency department with complaints of her head "not feeling right" and intermittent ataxia (episodes of imbalance and difficulty ambulating) reported by patient and patients' son. Physical exam only pertinent for chronic shuffling gait, but no ataxia. The patient underwent further work-up, demonstrating negative brain imaging for cerebral vascular accident and laboratory findings negative initially, for acute infection. An RPR was drawn as part of an broadened altered mental status workup as the patient and family stated she was not back to baseline mental status and was positive with a quantitative titer of 1:8. Fluorescent treponemal antibody absorption (FTA-ab) was found to be positive as well. The patient was started on three million units intravenous Penicillin G every 4 h and was discharged with a peripherally inserted central catheter in order to receive two weeks of Rocephin at two grams daily. Patient returned to prior baseline following completion of treatment. Through this case, we hope to provide information on neurosyphilis and its differentiation from other disease processes and when neurosyphilis should be suspected during an evaluation of altered mental status.