A Case of Neuro- and Otosyphilis Successfully Managed with a Sequential Regimen Including Ceftriaxone

Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system (CNS), which is characterized with complex and varied clinical manifestations and lacks early symptom specificity. It usually occurs when syphilis is untreated or poorly treated and can occur in any stage of syphilis, potentially causing severe neurological damage. Otosyphilis, characterized by auditory-vestibular dysfunction, may manifest independently without cerebrospinal fluid (CSF) abnormalities, or coexist with neurosyphilis, as a part of the neurological symptoms of neurosyphilis, and is particularly prone to misdiagnosis. However, the clinical prognosis of both neurosyphilis and otosyphilis is suboptimal in some cases, and many patients do not show improvement with aqueous penicillin administered intravenously. We report a rare case of neuro- and otosyphilis in an HIV-negative young male, successfully managed with a sequential regimen including ceftriaxone followed by benzathine penicillin-hearing was completely recovered and abnormal examination findings were resolved. This case illustrates the diagnostic key points of otosyphilis combined with neurosyphilis and supports the efficacy of a sequential regimen containing ceftriaxone in cases where first-line treatment options are limited.