• Marta Jankowska, Krystian Mross, Marcin Pałczyński, Karolina Machowska-Sempruch, Anna Bajer-Czajkowska, Miłosz Parczewski, and Marta Masztalewicz.
• Department of Neurology, Pomeranian Medical University, Szczecin, Poland.
• Medicine (Baltimore). 2022 Sep 16; 101 (37): e30586e30586.

RationaleSyphilis is a bacterial, systemic infectious disease caused by Treponema pallidum spirochetes, which spread rapidly through the body affecting various organs. The term neurosyphilis (NS) refers to a CNS infection that can occur at any stage of the disease. The lack of a gold standard for the diagnosis of NS greatly hinders diagnosis, which must be based mainly on clinical assessment.Patient ConcernsA 58-year-old man reported dizziness and headache for a week and right-sided hearing impairment, with suspected transient cerebral ischemic attack. A month later he experience transient speech disturbance and suspected cerebral ischemic stroke.DiagnosisMRI showed fresh ischemic lesions with a diameter up to 10 mm in the deep brain structures on the left side and foci of subacute ischemia also in the deep structures and the brain stem. Cerebrospinal fluid examination showed positive Pandy's reaction, doubtful Noone-Apelt reaction, increased protein level and decreased glucose level. The reactive result of the USR test performed (VDRL) finally allowed the diagnosis of symptomatic CNS syphilis.InterventionsEmpiric treatment for bacterial meningitis was administered. The patient was transferred to the Department of Infectious Diseases for further treatment.OutcomesThe diagnosis has been confirmed at the Department of Infectious Diseases after repeating CSF analysis including VDRL and FTA-ABS.LessonSymptoms of NS are nonspecific, hence the diagnostic process is not straightforward. Despite the availability of modern diagnostic techniques, establishing a final diagnosis was challenging, but the patient ultimately received appropriate treatment. It is important to remember that syphilis is not only a disease known from history lessons but is still present in modern times and its incidence is increasing.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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