Initially unrecognized dementia in a young man with neurosyphilis.
BACKGROUND
In general paresis, the invading spirochetes destruct the neurons resulting in impairments in memory, intellect, affect, and judgment of the infected patients. If neurosyphilis is diagnosed early enough, a timely effective treatment may not only prevent further progression of the disease but also allow complete recovery.


METHODS
We report a 35-year-old man with rapid cognitive deterioration. Neurotic depression with dementia was initially diagnosed and the patient was treated with antidepressants, with a poor response. Neurosyphilis with general paresis was diagnosed 1 year later. A 2-week course of intensive treatment with penicillin G was started. Persistent dementia and progressive brain atrophy were found 6 months later, despite an improved cerebrospinal fluid profile and cerebral blood flow indicated by serial single-photon emission computed tomography.


CONCLUSIONS
This case underscores the importance of early diagnosis of neurosyphilis, and the clinicians should alert the possibility of neurosyphilis in patients who present with dementia.
Lee
Chen-Hsiang
CH
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Lin
Wei-Che
WC
Lu
Cheng-Hsien
CH
Liu
Jien-Wei
JW
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003704:Dementia / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009494:Neurosyphilis / Q000150:complications* / Q000188:drug therapy; D010400:Penicillin G / Q000627:therapeutic use; D015899:Tomography, Emission-Computed, Single-Photon
D000900:Anti-Bacterial Agents; D010400:Penicillin G