Asymptomatic Neurosyphilis Presenting With Bilateral Pulmonary Nodules: A Case Report

Globally, syphilis cases have been increasing and pulmonary lesions have been reported. However, asymptomatic neurosyphilis has not been documented. This condition is often unrecognised and presents with symptoms similar to those of other infectious and non-infectious lung diseases. In syphilitic pneumonia, defined as a secondary form of syphilis, intramuscular injection of benzylpenicillin (24 million units) remains the gold standard for treatment, with a favourable prognosis. This report presents for the first time a case of asymptomatic neurosyphilis with multiple pulmonary nodules and buttock lipodystrophy. If rapid plasma reagin (RPR) antibody titres are high and RPR testing is difficult during follow-up, cerebrospinal fluid (CSF) examination may be considered for further evaluation of asymptomatic neurosyphilis. This case showed a high expression of RPR (154 R.U.) and given the nature of the patient's work (long-distance transportation), short-term follow-up was difficult. Therefore, CSF was performed to enable early diagnosis and treatment.