Neurosyphilis Presenting With Subtle Clinical Features: A Diagnostic and Therapeutic Challenge

We report the case of a 36-year-old male who presented with an acute onset of headache, vomiting, and feverish sensation with a history of prior unsafe sexual activity. VDRL and TPHA were reactive in both the blood and cerebrospinal fluid. A diagnosis of neurosyphilis was thus made, and we successfully treated the patient with ceftriaxone and doxycycline. With the increasing global trend of syphilis, the involvement of the central nervous system, neurosyphilis, is an increasing concern too. Due to the vague nonspecific symptoms and variable timing of presentation, it presents as a diagnostic challenge. We report this case to emphasize the need to explore the associated risk factors and consider neurosyphilis as a potential diagnosis because timely recognition and early treatment are essential to prevent irreversible neurological consequences.