Neurosyphilis (NS) is an infectious disease caused by Treponema pallidum invading the central nervous system. It can manifest at any stage of syphilis, and is often misdiagnosed due to its atypical and progressive symptoms. The increasing incidence of NS underscores the necessity for early and accurate diagnosis. Here, we present a case where routine cerebrospinal fluid metagenomic next-generation sequencing (mNGS) was used to diagnose a patient with neurosyphilis. The patient exhibited cognitive impairment and was initially diagnosed with cerebral infarction due to syphilitic cerebral arteritis. Thus, the patient was treated with dual antiplatelet therapy (aspirin and clopidogrel) and statins to stabilize the plaques. Neurosyphilis was treated with penicillin sodium injections, resulting in significant improvement in the patient's mental state. This case is a rare instance of neurosyphilis associated with cerebral infarction. These findings suggest that mNGS is a valuable tool in diagnosing neurosyphilis, potentially improving diagnostic accuracy and patient outcomes.
Humans ; Anti-Bacterial Agents/therapeutic use* ; Cognitive Dysfunction/etiology* ; High-Throughput Nucleotide Sequencing ; Neurosyphilis/drug therapy* ; Treponema pallidum/isolation & purification*

CD4 Lymphocyte Count ; HIV Infections/drug therapy* ; Humans ; Neurosyphilis/drug therapy*

The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.
Adult ; Anti-Bacterial Agents/administration & dosage ; Biopsy, Needle ; Chancre/diagnosis/pathology ; Diagnosis, Differential ; Encephalitis, Herpes Simplex/diagnosis ; Follow-Up Studies ; Humans ; Limbic Encephalitis/diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Neurosyphilis/*diagnosis/drug therapy/pathology ; Penicillins/administration & dosage ; Rare Diseases ; Temporal Lobe/*pathology ; Tongue/pathology