Revisiting Delirious Mania in the Context of Neurosyphilis: A Case Report

Delirious mania (DM) is a severe neuropsychiatric syndrome characterized by the acute onset of delirium, psychosis and increased psychomotor activity. Its classification remains debated, with overlapping features of mania, catatonia, and delirium complicating diagnosis and treatment. The condition poses significant challenges in differential diagnosis, particularly in patients with comorbid medical conditions.

We report the case of a 52-year-old man with bipolar disorder who presented with acute agitation, disorientation, confabulation, incontinence, and severe behavioral disturbances, initially suggestive of DM. Despite targeted psychiatric treatment, his condition remained refractory until a syphilitic infection was identified, with a possible presentation of neurosyphilis, and treated with antibiotic therapy. Resolution of his symptoms followed, with the delirium persisting briefly after the mania had subsided, suggesting an organic contribution to his presentation.

This case highlights the importance of considering organic etiologies, such as neurosyphilis, in presentations of DM. It also supports the view that DM may represent a syndromic entity with both psychiatric and medical underpinnings, rather than merely a subtype of bipolar disorder. Early identification and treatment of DM, along with any underlying medical conditions, are crucial for patient recovery.