Neurosyphilis: Diagnostic Challenges and Public Health Relevance – A Case Report

Authors

DOI:

https://doi.org/10.30834/KJP.38.2.2025.582

Keywords:

Neurosyphilis, Chronic meningovascular syphilis, Organic psychosis, Neuropsychiatry, Public health

Abstract

Background: Syphilis, caused by Treponema pallidum, remains a diagnostic challenge due to its varied clinical manifestations. Neurosyphilis, a late-stage complication, can mimic psychiatric disorders and lead to misdiagnosis.

Case Report: A middle-aged woman presented with progressive cognitive decline, personality changes, and psychotic symptoms. She was initially mistaken for a primary psychiatric illness. Serological testing confirmed neurosyphilis, and treatment with intravenous penicillin resulted in marked improvement in neuropsychiatric features. This case emphasizes the importance of considering syphilis in atypical psychiatric presentations, particularly given its global resurgence.

Conclusion: Early recognition and timely therapy are essential to prevent irreversible neurological damage, underscoring the need for heightened clinical vigilance and routine screening in at-risk populations.

Downloads

Download data is not yet available.

References

David AS, Fleminger S, Kopelman MD, Lovestone S, Mellers JDC, editors. Lishman's Organic Psychiatry: A Textbook of Neuropsychiatry. 4th ed. Oxford: Wiley-Blackwell; 2009. DOI:10.1002/9781444316803

Rosset F, Celoria V, Delmonte S, Mastorino L, Sciamarrelli N, Boskovic S, et al. The Epidemiology of Syphilis Worldwide in the Last Decade. J Clin Med. 2025 Jul 28; 14(15):5308. DOI: 10.3390/jcm14155308

Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev. 1999 Apr; 12(2):187-209. DOI: 10.1128/CMR.12.2.187

Funayama M, Kuramochi S, Kudo S. Neurosyphilis Initially Misdiagnosed as Behavioral Variant Frontotemporal Dementia: Life-Changing Differential Diagnosis. J Alzheimers Dis Rep. 2023 Sep 26; 7(1):1077-1083. DOI: 10.3233/ADR-230107

Stefani A, Riello M, Rossini F, Mariotto S, Fenzi F, Gambina G, et al. Neurosyphilis manifesting with rapidly progressive dementia: report of three cases. Neurol Sci. 2013 Nov; 34(11):2027-30. DOI: 10.1007/s10072-013-1531-5

Cintron R, Pachner AR. Spirochetal diseases of the nervous system. Curr Opin Neurol. 1994 Jun; 7(3):217-22. DOI: 10.1097/00019052-199406000-00007

Catalano AA, Yoon J, Fertuzinhos S, Reisert H, Walsh H, Kosana P, et al. Neurosyphilis is characterized by a compartmentalized and robust neuroimmune response but not by neuronal injury. Med. 2024 Apr 12; 5(4):321-334.e3. DOI: 10.1016/j.medj.2024.02.005

Yang Y, Gu X, Zhu L, Cheng Y, Lu H, Guan Z, et al. Clinical spectrum of late symptomatic neurosyphilis in China: an 11-year retrospective study. Sex Transm Infect. 2024 Nov 18; 100(8):477-483. DOI: 10.1136/sextrans-2024-056117

Ioannidis P, Lourbopoulos A, Mamouli D, Polichroniadou E, Papadopoulos G, Karacostas D. Neurosyphilis presenting as primary progressive aphasia. J Neuropsychiatry Clin Neurosci. 2014 Winter; 26(1):E27-8. DOI: 10.1176/appi.neuropsych.13010018

Mumtaz GR, Weiss HA, Thomas SL, Riome S, Setayesh H, Riedner G, et al. HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis. PLoS Med. 2014 Jun 17; 11(6):e1001663. DOI: 10.1371/journal.pmed.1001663

Ministry of Health and Family Welfare, Government of India. Health Management Information System [Internet]. New Delhi: MoHFW; [cited 2025 Aug 12]. Available from: https://hmis.mohfw.gov.in/

Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children (Basel). 2023 Jul 29; 10(8):1310. DOI: 10.3390/children10081310

Downloads

Published

25-12-2025

How to Cite

Merin Poulose, S. Mangalam, Anand Shajan, Varghese P Punnoose, and Joice James. “Neurosyphilis: Diagnostic Challenges and Public Health Relevance – A Case Report”. Kerala Journal of Psychiatry, Dec. 2025, doi:10.30834/KJP.38.2.2025.582.

Issue

Section

Case Report