Late syphilis can present with a wide range of neurological findings including psychosis.
Neurosyphilis may be associated with:
(1) asymptomatic
(2) cognitive dysfunction
(3) mood dysfunction including mania and depression
(4) psychosis
Syphilis may not be initially suspected. A careful social history, complete physical exam and antitreponemal serologic testing should be performed on patients with psychosis.
While penicillin therapy may result in clinical improvement, psychiatric symptoms may persist if advanced (Allen, 2014). Therefore, early diagnosis and therapy is important.
The differential diagnosis includes:
(1) pre-existing psychosis
(2) psychosis associated with drug use
(3) psychosis associated HIV
(4) post-partum psychosis
Some patients may have more than one reason to be psychotic.
