Neurosyphilis: the reemergence of an historical disease.

Syphilis, " the great imitator, " used to be part of the standard differential diagnosis of neuropsychiatric disease. With the advent of penicillin, the incidence of tertiary syphilis has greatly declined. The disease is now considered unusual in the developed countries, except in the context of human immunodeficiency virus infection. In a recent review of syphilis the authors stated that " late neurosyphilis is extremely rare in the antibiotic era " [1]. Non-HIV-related neurosyphilis became uncommon enough for the American Academy of Neurology to drop lumbar puncture from its suggested list of tests for dementia [2]. More recently a new focus of disease resurgence has emerged: there has been an up to 50-fold increase in the incidence of syphilis in the Russian Federation and other newly independent states of the former Soviet Union [3] since the early 1990s. Other than the local significance of this new trend, it may have repercussions beyond the borders of the former Soviet Union. An estimated 2 million citizens from the former USSR have moved since the Soviet collapse in 1989, mostly to North America, western Europe, and Israel. Another immigrant population with a high prevalence of positive trepone-mal serology (3–12%) is that arriving from Ethiopia. Physicians providing care to immigrants from the former Soviet Union and Ethiopia should be aware of the potential role of syphilis in the etiology of acute and subacute neuropsychiatric diseases in these patients, and should consider the entity in the differential diagnosis, when appropriate. We report the cases of two recent immigrants from the former USSR who were diagnosed with neurosyphilis, and take the HIV = human immunodeficiency virus occasion to remind the medical community of this forgotten entity. A 47 year old woman was hospitalized in a psychiatric hospital in June 2005 with sudden onset of psychotic symptoms for the first time in her life. Her medical history was unremarkable; she denied alcohol abuse or drug use and her family history for neurologic and psychiatric disorders was negative. The woman was married for 22 years; she had been a teacher in Georgia before arriving in Israel in February 2005. On admission she was oriented only to self, experienced intermittent agitation, expressed bizarre ideas, reported hearing hallucinatory voices, and had delusional thoughts. Her thought progression was illogical and often tangential, and her judgment was poor. She was alert, but made errors during recall, serial thinking and subtraction from 100, …