Neurosyphilis in Psychiatric Settings: Three Case Reports 2

Syphilis is a generally sexually transmitted and multisystem disease caused by the spirochete Treponema pallidum. All of the organs of the body may be involved during the course of the disease. Neurosyphilis is a clinical form of syphilis with central nervous system (CNS) involvement. While primarily meningeal and vascular structures are involved in early neurosyphilis, parenchymal regions of the brain and spinal cord emerges at later stages of neurosyphilis. It presents with symptoms of meningitis, meningovasculitis, and parenchymal neurosyphilis (presenting as tabes dorsalis and general paresis). Clinically, neurosyphilis can mimic a variety of psychiatric disorders such as depression, psychosis, mania, delirium, personality changes, and dementia. During its progression, syphilis has been defined as “great imitator” making its presentation similar to many systemic or neuropsychiatric diseases. Presently, neurosyphilis is a rare disease that must be kept in mind during the differential diagnosis of neurological and psychiatric disorders. In this article, three neurosyphilis cases with different psychiatric presentations are reported, and literature relevant to syphilis is reviewed.