J Korean Med Sci.  2020 Aug;35(33):e271. 10.3346/jkms.2020.35.e271.

Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review

• Lee SH
• Yang H
• Kang NR
• Park JH

• KMID: 2505591
• DOI: http://doi.org/10.3346/jkms.2020.35.e271

Abstract

Infectious diseases of immigrant populations have recently become important issues for the health of both Korean nationals and foreigners living in Korea. This case report of general paresis is intended to raise awareness about re-emerging neurosyphilis in Korea as a possible etiology of psychotic disorders. A 68-year-old male Chinese resident came to Korea in 2019 with disorientation, auditory hallucination, persecutory delusion, and aggressive behavior, and was admitted to a psychiatric ward for further evaluation and treatment via the emergency department. He was confirmed to have neurosyphilis by serum test, analysis of cerebrospinal fluid, and brain magnetic resonance imaging. After treatment with antibiotics, including intravenous penicillin, in combination with atypical antipsychotics for 6 weeks, his disorientation, auditory hallucination, delusion, and aggressive behavior had attenuated. Neurosyphilis should still be included as a possible etiology of psychotic disorders in Korea. At the initial evaluation, syphilis screening serum tests are recommended for psychotic patients, especially those with pleomorphic symptoms and cognitive dysfunction.

Keyword

General Paresis; Neuropsychiatric Deficits; Neurosyphilis

Figure

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  Fig. 1 Brain computed tomography and brain magnetic resonance imaging of the patient. (A) Non-enhanced computed tomography axial view. (B) T1-weighted axial and sagittal images. (C) T2-weighted fluid attenuated inversion recovery axial images. Published under agreement of the patient's guardian.

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  Fig. 2 Algorithm of diagnosis of neurosyphilis in a patient without HIV infection. Adapted from Marra CM. UpToDate.14HIV = human immunodeficiency virus, FTA-ABS = fluorescent treponemal antibody absorption test, TPPA = Treponema pallidum particle agglutination assay, TP-EIA = Treponema pallidum enzyme immunoassays, CIA = chemiluminescence immunoassays, NS = neurosyphilis, CSF = cerebrospinal fluid, VDRL = venereal disease research laboratory test, WBC = white blood cell.

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