An Adolescent With Neurosyphilis

Neurosyphilis is a central nervous system (CNS) infection that has become exceedingly rare in the postantibiotic era, especially in children and HIV-negative persons. It can develop during any stage of an untreated syphilis infection and is known as “the great imitator” for its highly variable clinical presentation with inconsistent lab and imaging findings. We describe the case of a previously healthy 17-year-old boy who presented with 2 weeks of right thumb and middle finger myoclonus followed by right upper extremity focal seizures with secondary generalization. Routine and confidential psychosocial history using the HEADSS (Home; Education, Eating, and Exercise; Activities; Drugs; Sexuality; Suicide and Sleep) assessment revealed that our patient was sexually active with one female partner, prompting sexually transmitted infection (STI) screening. The final diagnosis of neurosyphilis was made following a reactive rapid plasma reagin screen and confirmatory treponemal testing of the cerebrospinal fluid. In light of the recent rise in syphilis case incidence and the devastating consequences of CNS involvement, neurosyphilis should be considered in the differential diagnoses for all sexually active adolescents with unexplained neurologic symptoms. Additionally, this case highlights the importance of comprehensive and confidential social history taking in all adolescents, as well as regular STI screening for those at risk.