Initially unrecognized dementia in a young man with neurosyphilis

Background: In general paresis, the invading spirochetes destruct the neurons resulting in impairments in memory, intellect, affect, and judgment of the infected patients. If neurosyphilis is diagnosed early enough, a timely effective treatment may not only prevent further progression of the disease but also allow complete recovery. Case Report: We report a 35-year-old man with rapid cognitive deterioration. Neurotic depression with dementia was initially diagnosed and the patient was treated with antidepressants, with a poor response. Neurosyphilis with general paresis was diagnosed 1 year later. A 2-week course of intensive treatment with penicillin G was started. Persistent dementia and progressive brain atrophy were found 6 months later, despite an improved cerebrospinal fluid profile and cerebral blood flow indicated by serial single-photon emission computed tomography. Conclusion: This case underscores the importance of early diagnosis of neurosyphilis, and the clinicians should alert the possibility of neurosyphilis in patients who present with dementia.