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Autopsy and Case Reports
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Atypical behavioral and psychiatric symptoms: Neurosyphilis should always be considered

Lucas Lonardoni Crozatti; Marcelo Houat de Brito; Beatriz Noele Azevedo Lopes; Fernando Peixoto Ferraz de Campos

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Syphilis still remains a major health concern worldwide because of the possibility of serious medical and psychological consequences, long-term disability, and death. Neurosyphilis (NS) may occur at any stage of infection. Its clinical presentation has been changing over recent years including­ psychiatric and neurocognitive symptoms. Several recent studies have described cases with these symptoms as the principal signs of NS. We present the case of neurosyphilis with a psychiatric presentation characterized by mood disturbance and auditory and visual hallucinations.


Neurosyphilis, Depression, Hallucinations, Diagnosis, Cerebrospinal fluid


Studahl M, Lindquist L, Eriksson BM, et al. Acute viral infections of the central nervous system in immunocompetent adults: diagnosis and management. Drugs. 2013;73(2):131-58. []. [PMID:23377760]

Seehusen DA, Reeves MM, Fomin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68(6):1103-8. [PMID:14524396]

Vermes, LMS. Proteinas do liquido cefalorraqueano: II. Valores normais das frações proteicas obtidas por eletroforese (variações ligadas a cor, sexo e idade). Arq Neuropsiquiatr. 1983;41(1):9-24. []. [PMID:6870591]

World Health Organization. Global incidence and prevalence of selected curable sexually transmitted infections - 2008. Geneva: WHO Press; 2012. [cited 2015 Aug 8]. Available from:

Costiniuk CT, MacPherson PA. Neurocognitive and psychiatric changes as the initial presentation of neurosyphilis. CMAJ. 2013;185(6):499-503. []. [PMID:23439623]

Bhai S, Lyons JL. Neurosyphilis update: atypical is the new typical. Curr Infect Dis Rep. 2015;17(5):481. []. [PMID:25896752]

Ghanem KG. Neurosyphilis: a historical perspective and review. CNS Neurosci Ther. 2010;16(5):e157-68. []. [PMID:20626434]

Kambe T, Shimura H, Ueno Y, et al. Vivid visual hallucinations manifested as the initial symptom in a patient with neurosyphilis. Psychosomatics. 2013;54(3):284-5. []. [PMID:23021085]

Knudsen RP. Neurosyphilis: overview of syphilis of the CNS. New York: Medscape; 2011. [cited 2015 Aug 8]. Available from:

Yao Y, Huang E, Xie B, Cheng Y. Neurosyphilis presenting with psychotic symptoms and status epilepticus. Neurol Sci. 2012;33(1):99-102. []. [PMID:21468681]

Lin LR, Zhang HL, Huang SJ, et al. Psychiatric manifestations as primary symptom of neurosyphilis among HIV-negative patients. J Neuropsychiatry Clin Neurosci. 2014;26(3):233-40. []. [PMID:24737221]

Ropper AH, Samuels MA, Klein JP. Adams and Victor’s principles of neurology. In: Ropper AH, Samuels MA, Klein JP, editors. Infections of the nervous system (bacterial, fungal, spirochetal, parasitic) and sarcoidosis. 10th ed. Boston: McGraw-Hill; 2014. chap. 32; p. 723-8.

Levchik N, Ponomareva M, Surganova V, Zilberberg N, Kungurov N. Criteria for the diagnosis of neurosyphilis in cerebrospinal fluid: relationships with intrathecal immunoglobulin synthesis and blood-cerebrospinal fluid barrier dysfunction. Sex Transm Dis. 2013;40(12):917-22. []. [PMID:24220351]

Vartdal F, Vandvik B, Michaelsen TE, Loe K, Norrby E. Neurosyphilis: Intrathecal synthesis of oligoclonal antibodies to Treponema pallidum. Ann Neurol. 1982;11(1):35-40. []. [PMID:7036846]

Zheng D, Zhou D, Zhao Z, et al. The clinical presentation and imaging manifestation of psychosis and dementia in general paresis: a retrospective study of 116 cases. J Neuropsychiatry Clin Neurosci. 2010;23(3):300-7. []. [PMID:21948891]

Torres GA, Lopes MHI, Cheuiche EM, Guilhermano LG. Profile of patients treated with malariotherapy in a psychiatric hospital in Porto Alegre, Brazil: a historical note. Trends Psychiatry Psychother. 2014;36(3):169-72. [].

Marra CM, Maxwell CL, Tantalo L, et al. Normalization of cerebrospinal fluid abnormalities after neurosyphilis therapy: does HIV status matter? Clin Infect Dis. 2004;38(7):1001-6. []. [PMID:15034833]


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