De grote imitator neurosyfilis

Background

Neurosyphilis is a tertiary form of syphilis and is caused by the spirochete Treponema pallidum. Today, more than one type of neurosyphilis often manifest simultaneously, which can pose difficulties to the diagnostic process.

Case description

A 45-year-old man presented with an attack of stammering and loss of strength in the right half of his body. Diagnostic testing led to a suspected TIA and the man was treated as such. It was only a few months later, when he had developed more neurological symptoms, that the diagnosis of ‘neurosyphilis’ was made. Despite treatment with benzyl penicillin, he also developed symptoms of a psychiatric nature.

Conclusion

The patient described in this article had symptoms consistent with both meningovascular syphilis and generalised paresis. Detailed history-taking was necessary to make the diagnosis (the patient had a history of gonorrhoea). A seemingly insignificant detail - an elevated estimated sedimentation rate - was an important clue.

Conflict of interest and financial support: disclosure forms provided by the authors are available along with the full text of this article at www.ntvg.nl, search for A6033; click on ‘Belangenverstrengeling’ (‘Conflict of interest’).