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Abstract Details

Atypical Presentation of Neurosyphilis: A Case Report
Infectious Disease
P5 - Poster Session 5 (8:00 AM-9:00 AM)
10-009
To present an atypical case of neurosyphilis in a 45-year-old male, highlighting its unusual presentation and the importance of considering it in differential diagnoses for acute neurological events.  
Neurosyphilis can manifest in various ways, often complicating the clinical picture. This condition is frequently overlooked, particularly when presenting alongside stroke symptoms. While cerebrospinal fluid (CSF) VDRL is the gold standard for diagnosis, it is known to have low sensitivity and can yield false negatives in patients with compatible symptoms. 
N/A 

A 45-year-old incarcerated male with a medical history of hypertension, type II diabetes mellitus, and hyperlipidemia presented with acute onset altered mental status and expressive aphasia. Imaging studies revealed an acute/subacute left middle cerebral artery infarct with proximal inferior trunk occlusion and a chronic right cerebellar infarct, prompting an extensive workup for stroke in younger patients. 

Further evaluation through a cerebral angiogram revealed subtle irregularities in the intracranial arteries. As a result, a lumber puncture was performed, which indicated slightly elevated protein and leukocyte counts. Serological testing confirmed latent syphilis. Despite a negative CSF VDRL test, the diagnosis of neurosyphilis was established based on the clinical presentation and positive treponemal blood test. The patient was treated successfully with a 14-day course of intravenous penicillin. 
This case emphasizes the necessity of considering neurosyphilis in patients presenting with atypical stroke symptoms, particularly those with risk factors such as incarcerated populations, unprotected sex and multiple sexual partners. Neurological complications are often disabling therefore, early recognition along with a multidisciplinary approach is crucial as to preventing long-term neurological complications and preserving quality of life, reinforcing the evolving understanding of neurosyphilis in clinical practice. 
Authors/Disclosures
Abhishek Vyas
PRESENTER 		Mr. Vyas has nothing to disclose.
Samir Cayenne Mr. Cayenne has nothing to disclose.
Suraj N. Vodnala, MD Mr. Vodnala has nothing to disclose.
Camila Narvaez Caicedo, MD Dr. Narvaez Caicedo has nothing to disclose.
Hashem Shaltoni, MD Dr. Shaltoni has nothing to disclose.