Neurosyphilis in a middle-aged woman with rapid cognitive decline and psychosis: A case report

Abstract

Neurosyphilis is an infection caused by the Treponema pallidum bacterium, affecting the central nervous system 1 . Considering the mutable manifestations of neurosyphilis, its diagnosis should be suspected in patients presenting psychiatric symptoms, including psychosis 2 , mania 3 , and decline in cognitive function 4 . Furthermore, early differential diagnosis may facilitate its treatment management and improve its prognosis. Therefore, the possibility of organic etiology, including neurosyphilis, should be considered by clinicians when neuropsychiatric manifestations develop.We report the case of a 44-year-old female patient, who continuously reported rapid cognitive decline, auditory hallucination, and persecutory delusion for 1 year and was admitted to the psychiatric ward of our hospital. Although a suboptimal therapeutic dose of antipsychotic was administered to the patient the previous year to alleviate her psychotic symptoms, extrapyramidal symptoms (EPS) were observed. While unsteady gait with frequent falls were reported in the following months, brain computed tomography and magnetic resonance imaging did not show any significant findings. Single-photon emission computed tomography revealed mild decreased frontal and parietal perfusion.Given the patient's Mini-Mental State Examination score of 10/30, the possible organic cause of her rapid cognitive decline was evaluated. Therefore, syphilis testing was also arranged. Following serologic tests on blood serum, rapid plasma reagin (RPR) and treponema pallidum hemagglutination (TPHA), positive results were observed at serum titers of 1/8 and >1/5120, respectively. In contrast, the cerebrospinal fluid (CSF) analysis reported both the protein and glucose levels to be 46 and 69 mg/dl, respectively, and an absence of white blood cells. In addition, the RPR and TPHA were positive at 1/2 and >1/5120 serum titers, respectively. As a result, the neurologist confirmed the neurosyphilis diagnosis. Therefore, a benzathine benzylpenicillin treatment was prescribed to the patient, together with an amisulpride (200~600 mg/day) and valproate (1200 mg/day) therapy to alleviate her psychiatric symptoms. The patient was thus able to maintain relatively stable mental conditions in the nursing home for more than a year and admission to acute psychiatric ward was not required.This case report may support the consideration of neurosyphilis as a differential diagnosis for patients with psychotic symptoms, especially when combined with rapid cognitive decline, sensitivity

Effects of hemp seed alone and combined with aerobic exercise on metabolic parameters, oxidative stress, and neurotrophic factors in young sedentary men

“…Besides beneficial metabolic properties, hemp seeds could prevent neurodegenerative diseases due to their antioxidant and anti‐inflammatory properties (Huang et al, 2021; Zhou et al, 2018). In an animal model, hemp seed extract improved learning and memory impairment in the mice receiving chemical drugs (Zhou et al, 2018).…”

“…Besides beneficial metabolic properties, hemp seeds could prevent neurodegenerative diseases due to their antioxidant and antiinflammatory properties (Huang et al, 2021;Zhou et al, 2018).…”