Psychotic mania as the solitary manifestation of neurosyphilis

Abstract

BackgroundNeurosyphilis remains a diagnostic challenge in current psychiatric practice because of its pleomorphic psychiatric manifestations. Although neurosyphilis can present with a wide range of psychiatric symptoms, psychotic mania as its solitary manifestation is an unusual phenomenon.Case presentationA 46-year-old man, with no history of any psychiatric disorder, exhibited abruptly developed symptoms of psychotic mania. He was admitted to a psychiatric ward for further evaluation and treatment. Upon admission, his cognitive function was unimpaired, and the hyperactivity was not severe. Also, no abnormalities were found upon neurological examination and brain magnetic resonance imaging. He was initially diagnosed as bipolar disorder with psychotic features. On the 3rd day after admission, he was confirmed as having neurosyphilis by analysis of cerebrospinal fluid and treated with intravenous penicillin—in combination with blonanserin—an atypical antipsychotic drug. After 2 weeks of treatment, most of the symptoms had abated.ConclusionsThe present case emphasizes that patients presenting with atypical psychiatric manifestation should be screened for possible syphilis, particularly in the absence of previous psychiatric history, and suggests that combination of blonanserin with antibiotic therapy may be effective in the treatment of the manic and psychotic symptoms secondary to neurosyphilis.

Challenges of diagnostics and treatment of non-specific mental health disorders in neurosyphilis

“…The au thors also note the dif fi culty to dif fer en ti ate be tween or ganic and non-organic psy cho ses, and the mar gin for er ror here is high [7]. An other sim i lar case was re ported by Seo et al (2018) where the pa tient had acute psy chotic ma nia with de lusions of gran deur, eu phoric mood, hy per ac tiv ity, and hallu ci na tions. The case also il lus trates that spe cific an ti bacte rial treat ment leads the pa tients to re mis sion very quickly and ef fec tively [8].…”

“…An other sim i lar case was re ported by Seo et al (2018) where the pa tient had acute psy chotic ma nia with de lusions of gran deur, eu phoric mood, hy per ac tiv ity, and hallu ci na tions. The case also il lus trates that spe cific an ti bacte rial treat ment leads the pa tients to re mis sion very quickly and ef fec tively [8]. Crozatti et al (2015) re ported a case with a dif fer ent clin i cal course -the man i fes ta tion of the dis ease was of a de pres sive na ture with sui cidal thoughts and cog ni tive dis tur bances.…”

Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review

“…Recently, the cases of general paresis and neurosyphilis was also reported in 2017 and 2018. 6 7 However, the diagnosis of neurosyphilis with psychotic features tends to be overlooked in Korea.…”

“… 5 In Korea, the most recent case of neurosyphilis was reported in 2018 and a case of general paresis in neurosyphilis was last reported in 2017. 6 7 Population mobility, such as immigration and refugee crises, is increasingly influencing the globalization of disease. 8 The foreign population in Korea, including migrant workers, has been growing rapidly, increasing from 1.3 million in 2012 to 2.36 million in 2018, accounting for 4.8% of the total population of Korea.…”

Quand une paralysie générale débutante était considérée comme un facteur de créativité. L’exemple de Gaetano Donizetti

“…Ainsi Bäzner et Hennerici en conclusion de leur article sur la syphilis chez les compositeurs de langue allemande (4) écrivent: "we can only speculate about the possible link between neurosyphilis and creativity through the severe organic disturbance of the neural networks…Likewise, a disease-mediated disinhibition of the fronto-subcortical circuits might interfere with creativity" A cet égard, il était classiquement dit que les lésions initiales de la PG touchaient le cortex frontal. Une revue de la littérature des cas récents (rares) de neurosyphilis ayant débuté par des troubles psychiatriques découvre en imagerie des lésions diverses (23) ou aucune lésion comme dans le cas récent de Seo et al (26). Saladini et al (25), dans l'observation récemment présentée d'un malade hospitalisé pour un épisode délirant à thème de persécution, ont découvert à l'IRM des lésions mésio-temporales gauches (régressives après traitement).…”