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Neurosyphilis mimicking autoimmune encephalitis in a 52-year-old man
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Neurosyphilis mimicking autoimmune encephalitis in a 52-year-old man
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Journal Article
Neurosyphilis mimicking autoimmune encephalitis in a 52-year-old man
2017
Overview
A 52-year-old man in a long-term, same-gender sexual relationship presented with agitation, confusion and problems speaking for about two weeks. On assessment, his vital signs were normal, but he was agitated and had global aphasia. No other focal deficits were identified on a screening neurologic examination. He suffered a witnessed generalized tonic-clonic seizure in the emergency department and was given a loading dose of phenytoin. Seizure activity stopped, but his agitation, confusion and aphasia persisted. During that admission, he had improved without any antimicrobial or immunotherapy and been discharged with outpatient speech therapy for mild word-finding difficulties. Three months later, however, he was again admitted with agitation, confusion and aphasia. In light of the authors' experience, they suggest considering syphilis testing in patients with possible autoimmune encephalitis, especially those with temporal lobe abnormalities on neuroimaging, to avoid diagnostic delay in atypical cases such as theirs. The US Centers for Disease Control and Prevention also recommends that HIV-infected persons and sexually active men who have sex with men be screened for syphilis at least annually.
