Diagnostic approach to neurosyphilis

Aproximación diagnóstica de la neurosífilis

Neurosyphilis (NS) is a disease affecting the central nervous system (CNS) caused by the spirochete bacteria Treponema pallidum; it may occur in immunocompetent patients but it more generally presents in patients with human immunodeficiency virus (HIV). The latter are more severe cases featuring a wide variety of neurological manifestations. Although the typical form is the most common, there are atypical expressions that may occur in 30% of cases as evidenced by neuroimaging studies, so recognition is important in order to ensure an early diagnosis and timely intervention. It is not only a public health problem due to its prevalence but also because of the broad clinical spectrum for which it has been called the great imitator. However, primary care physicians may not be aware of these manifestations. The following work has been proposed based on three clinical cases (two patients with CNS vasculitis and one with panuveitis) with the aim of demystifying NS forms of presentation and clarifying clinical manifestations involving the CNS, to perform an accurate diagnosis and initiate a proper and timely treatment to reduce sequelae.