Neurosyphilis presenting as parkinsonism

• Published in: BMJ case reports Vol. 2015; p. bcr2015210277
• Main Authors: McAuley, John, Hughes, Gaenor
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 28.09.2015; BMJ Publishing Group
• Series: Case Report
• Subjects: Antibiotics; Ataxia; Diagnosis, Differential; Humans; Infections; Magnetic Resonance Imaging - methods; Male; Middle Aged; Mortality; Neurodegeneration; Neurosyphilis - diagnosis; Neurosyphilis - drug therapy; Parkinson Disease - diagnosis; Parkinson Disease - drug therapy; Parkinson's disease; Proteins; Psychosis; Tomography, Emission-Computed, Single-Photon - methods; United Kingdom; Unusual Presentation of More Common Disease/Injury; Viral infections; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2015-210277

In the postantibiotic era, neurosyphilis continues to have a significant incidence, especially in certain subpopulations. We report, for the first time, neurosyphilis presenting as parkinsonism without more typical neurosyphilitic clinical features. A 53-year-old man developed clinical features of gradual onset consistent with idiopathic Parkinson's disease but was found to have positive treponemal serology and cerebrospinal fluid Venereal Disease Research Laboratory (VRDL) reaction. Antibiotic treatment dramatically improved all the parkinsonian symptoms. However, over the subsequent 15 years, the patient slowly deteriorated again in a manner typical of idiopathic Parkinson's disease. A dopaminergic deficit was demonstrated on (123I)FP-CIT SPECT. This is the first report in the postantibiotic era of neurosyphilis presenting as relatively pure parkinsonism. Blood test screening for syphilis is therefore appropriate if there is any clinical doubt about an idiopathic parkinsonian presentation. The patient's late second deterioration may suggest that the neurosyphilitic basal ganglial insult primed or accelerated development of idiopathic-like disease.