Neurosyphilis: a complex presentation and diagnostic challenge in a psychiatric setting

Neurosyphilis presents a significant diagnostic challenge in psychiatric settings due to its highly variable neuropsychiatric manifestations, which can mimic a range of other psychiatric disorders. This case report describes a 36-year-old male admitted with acute psychotic symptoms, including hallucinations, delusions, and disorganized behavior. His clinical history revealed previously treated syphilis, with no subsequent follow-up, and recent progressive cognitive and behavioral changes, ultimately leading to a diagnosis of neurosyphilis (specifically general paresis) following serological confirmation. This case highlights the complexities in diagnosing neurosyphilis, as its symptoms often overlap with common psychiatric conditions, making it easy to overlook in routine assessments. Importantly, the diagnosis required a high index of suspicion due to the patient’s psychiatric presentation combined with a background of untreated syphilis. Considering neurosyphilis in the differential diagnosis can be challenging, especially when psychiatric symptoms like depression, cognitive decline, and psychosis appear in the absence of clear neurological signs and when there is no follow-up on prior infections. The resurgence of syphilis and its neurological complications remains a concern, particularly in psychiatric populations where risk factors such as substance use disorders, socioeconomic challenges, and limited access to healthcare are prevalent. This case underscores the critical role of psychiatrists in screening for syphilis, especially in patients at risk or in areas with high syphilis prevalence. Early and accurate diagnosis, coupled with appropriate treatment using penicillin, can halt disease progression and mitigate severe neuropsychiatric outcomes. This case underscores the importance of maintaining a broad differential diagnosis in psychiatric patients and considering neurosyphilis in cases of unexplained psychiatric symptoms.