title: The importance of not jumping to conclusions: syphilis as an organic cause of neurological, psychiatric and endocrine presentations.
abstract: A 66-year-old Caucasian man was admitted to an acute psychiatric ward under section 2 of the Mental Health Act after presenting with auditory hallucinations and partition delusions. He had been known to mental health services since 2005 but had never been treated with psychotropic medication or given a formal psychiatric diagnosis. He was also diagnosed with hypopituitarism of unknown aetiology in 2002. In light of this presentation, his medical history was reviewed in full, hormone levels and a full delirium screen including blood borne virus and syphilis serology was completed to ensure no organic cause had been missed. The treponemal antibody was positive, and he reported no previous syphilis treatment, as such a diagnosis of neurosyphilis was performed. This case demonstrates a patient presenting with two potential complications of syphilis; psychosis and hypopituitarism where screening for this infection had not been previously considered.
authors.affiliation: Psychosis CAG, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Health Service and Population Research, London, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Noblett
authors.affiliation: Department of Psychological Medicine, Weston Education Centre, Kings College London, London, UK.
authors.forename: Emmert
authors.initials: E
authors.lastname: Roberts
mesh_terms: D000368:Aged; D000728:Androgens / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003702:Delusions / Q000382:microbiology; D004359:Drug Therapy, Combination; D006212:Hallucinations / Q000382:microbiology; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009494:Neurosyphilis / Q000097:blood / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D011567:Psychiatric Department, Hospital; D011618:Psychotic Disorders / Q000382:microbiology; D013588:Syphilis Serodiagnosis / Q000379:methods; D016896:Treatment Outcome; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification*
chemical_list: D000728:Androgens; D000900:Anti-Bacterial Agents; D014150:Antipsychotic Agents