Neurosyphilis: An Unresolved Case of Meningitis

Abstract EN

Neurosyphilis can cause both symptomatic and asymptomatic meningitis.

However the epidemiology of modern neurosyphilis is not well defined because of the paucity of population-based data.

The majority of neurosyphilis cases have been reported in HIV-infected patients.

Here we present a case of early neurosyphilis/symptomatic syphilitic meningitis in a non-HIV patient who presented with rash but was mistakenly treated for early latent or secondary syphilis.

Syphilis presenting with a skin rash and an extremely high RPR titer could indicate CNS infection rather than simply secondary syphilis because rash is a nonspecific manifestation of disseminated infection.

Given the effectiveness of penicillin therapy, why is the rate of syphilis continuing to increase? Is it due to a failure of prevention or could it be also because of failure to diagnose and treat syphilis adequately, as in this case?