Otoneurosyphilis masquerading as neurofibromatosis type II

We present a case report of a 75-year-old patient with bilateral sensorineural hearing loss, vertigo and progressive neurological deficits. MRI scans showed multiple intracranial lesions. In the light of positive serological tests for syphilis, these unusual radiological features might represent gummatous lesions which were in keeping with a diagnosis of tertiary syphilis with otological and neurological involvement. The patient was treated with Bicillin and corticosteroids with initial improvement, but succumbed rapidly with multiple neurological deficits. The radiological differential diagnosis included neurofibromatosis type II in this case, which illustrates that neurosyphilis can mimic other neurological diseases. The literature on neurosyphilis is reviewed.