Neurosyphilis presenting as cranial nerve palsy, an entity which is easy to miss

Abstract

Neurosyphilis is a rare disease that until the 2000s was almost eradicated due to population awareness of HIV and efficient treatment. Since then, the prevalence of the entity is rising due to risk-associated behaviour such as unprotected intercourse. Neurosyphilis is still a difficult entity to diagnose especially when combined with acute HIV infection which can influence the usual clinical course of disease. In rare occasions, both acute HIV and early syphilis infection can present as mono or multiple cranial nerve palsies. This case demonstrates a rare manifestation of misdiagnosed early syphilis infection combined with acute HIV infection in a 34-year-old man with prior history of unprotected sex with men.

Keywords: HIV / AIDS; infection (neurology); meningitis; syphilis.

Figure 1

Brain MRI. (A) Axial postgadolinium T1-weighted images showing slight diffuse enhancement of Left facial nerve (B) Coronal postgadolinium T1-weighted images showing slight diffuse enhancement of facial cochlear nerves complex (arrows).