Cerebrospinal Meningitis in the Course of Secondary Syphilis

Introduction
In recent years, syphilis incidence has risen, while its diagnosis remains challenging due to the heterogeneity of clinical manifestations across multiple organ systems.

Case report
A 45-year-old patient was admitted to the Dermatology Department because of ulcers on mucosal membranes and scalp area and subtle neurological symptoms. The patient has been treated with nystatin, fluconazole, miconazole and acyclovir without any improvement. He was being examined for bullous diseases but the results were negative. The venereal disease research laboratory (VDRL) test, the fluorescent treponemal antibody (FTA) test , the fluorescent treponemal antibody absorption (FTA-ABS) test, and the Treponema pallidum hemagglutination assay (TPHA) were positive in serum. Cerebrospinal fluid examination revealed pleocytosis and positive results of the fluorescent treponemal antibody (FTA) test, the fluorescent treponemal antibody absorption (FTA-ABS) test, and the Treponema pallidum hemagglutination assay (TPHA). The patient was diagnosed with syphilitic meningitis.

Conclusions
The clinical manifestations of syphilis are diverse and may be misleading. Therefore, screening for syphilis appears to be warranted, particularly in patients with high-risk sexual behaviors.