SHM Converge Scientific Abstract ePoster Gallery-Neurosyphilis: An Unexpected Finding in a Patient Presenting With Seizures

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This case describes a 41-year-old man with intravenous drug use who presented in status epilepticus after two months of psychiatric and neurobehavioral symptoms, including catatonia, hallucinations, and paranoia. He required intubation and ICU admission. Continuous EEG showed epileptiform activity. Initial CT head was normal, but MRI with T2/FLAIR and contrast showed symmetric bilateral temporal lobe enhancement, raising concern for viral or autoimmune encephalitis.<br /><br />Further evaluation revealed a reactive RPR and positive herpes simplex IgG, while HIV, Lyme, and drug screen were negative. Infectious disease was consulted and broad empiric therapy was started with acyclovir, vancomycin, ceftriaxone, and doxycycline. Lumbar puncture showed lymphocytic pleocytosis. CSF VDRL returned positive at 1:16, while HSV PCR and autoimmune encephalitis testing were negative. Based on these findings, acyclovir was stopped and treatment was narrowed to high-dose penicillin G. The patient improved clinically, and repeat MRI showed improvement in the temporal abnormalities.<br /><br />The discussion emphasizes that syphilis, the “great imitator,” can present in many forms and may mimic viral or autoimmune encephalitis, including rare syphilitic encephalitis with temporal lobe involvement. Neurosyphilis may present with seizures, cognitive changes, psychiatric symptoms, ocular findings, or other neurologic deficits. Diagnosis is supported by CSF VDRL or RPR, usually along with lymphocytic pleocytosis and elevated protein.<br /><br />Key takeaway: neurosyphilis should remain on the differential for patients with unexplained neurologic or psychiatric symptoms, because early recognition and treatment with penicillin can lead to significant improvement.

Asset Subtitle

Ben Purugganan

Meta Tag

Author List Ben Purugganan, Kim Jordan

Category Clinical Vignettes

Concept Neurosyphilis

Concept Penicillin G

Concept Syphilis Serology

Concept Cerebrospinal Fluid Venereal Disease Research Laboratory Test

Concept Seizure

Distinguished Non-Finalist

Presenter Organization Riverside Methodist Hospital

Presenting Author Ben Purugganan

Track Adult

Keywords

neurosyphilis

syphilitic encephalitis

status epilepticus

temporal lobe enhancement

psychiatric symptoms

catatonia

hallucinations

CSF VDRL

penicillin G

encephalitis

Neurosyphilis

Penicillin G

Syphilis Serology

Cerebrospinal Fluid Venereal Disease Research Laboratory Test

Seizure