Neurosyphilis Reemergence in the Modern Day: A Case Report

Syphilis, once considered a disease in decline, has re-emerged as a significant public health concern in the United States. This case report presents the clinical course of a 42-year-old male with a rare presentation of neurosyphilis. The patient presented twice to the ER within 60 days with vague intermittent symptoms, including numbness/tingling of his hands and feet, which the patient initially ignored. This progressed into balance issues, tinnitus, difficulty focusing, inattentiveness, and behavior changes. Family states he had started behaving very oddly, had wax-and-waning confusion, and also had a moment where he was hallucinating. The patient's first evaluation in the ER was roughly three weeks prior to the second visit. The workup included a CT of the head, which was negative, among other tests for toxic/metabolic causes. After a grossly unremarkable workup at the initial visit, the patient was further discharged at that time. At home, the patient stated his symptoms continued, he followed up with his PCP as he was directed, and the PCP ordered a rapid plasma reagin (RPR) test for continued symptoms and found the patient to be RPR (+). The patient then presented to the ED for a second evaluation sent by PCP with a RPR (+), continued symptoms, and requested further evaluation. On a more comprehensive social history investigation, the patient reported a painless penile lesion roughly three years ago after a sexual encounter. The lesion went away on its own, and the patient never sought treatment for the lesion. On the second ER presentation, the patient then had a more in-depth workup, including lumbar puncture results, which showed suspicion of neurosyphilis. The patient was then admitted with disposition for treatment of neurosyphilis. While admitted to the hospital, the patient was reported as remaining stable, clinically improved, and was appropriately treated for neurosyphilis with 14 days of IV antibiotics. The patient was in the hospital for a total of a week and then discharged home with IV antibiotics set up for home completion of the 14-day course for the treatment of neurosyphilis.