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Cerebrospinal fluid (CSF) examination revealed an elevated CSF protein of 52\u2009mg\/dL and CSF Venereal Disease Research Laboratory (VDRL) of 1:1.\u202fPenicillin was started. The patient developed a Jarisch-Herxheimer reaction soon after. He had a fever, rash and worsening headaches due to the enlargement of subdural haematoma for which he underwent a burr hole drainage. Vision improved after completing penicillin therapy but did not recover fully. The CSF VDRL became non-reactive and serum RPR titre decreased to 1:8 3\u2009months later.<\/jats:p>","DOI":"10.1136\/bcr-2024-260588","type":"journal-article","created":{"date-parts":[[2024,9,10]],"date-time":"2024-09-10T23:00:16Z","timestamp":1726009216000},"page":"e260588","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Syphilis presenting as optic neuritis and subdural haematoma with complicating neuro Jarisch-Herxheimer reaction"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0518-5394","authenticated-orcid":false,"given":"Jaspreet","family":"Kaur","sequence":"first","affiliation":[{"name":"Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas A","family":"Melgar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Pediatrics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munzer","family":"Abdulhak","sequence":"additional","affiliation":[{"name":"Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"},{"name":"Bronson Methodist Hospital, Kalamazoo, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7986-7189","authenticated-orcid":false,"given":"Emma","family":"Sand","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,9,10]]},"reference":[{"key":"2025082709302796000_17.9.e260588.1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e3181644b5e"},{"key":"2025082709302796000_17.9.e260588.2","article-title":"Blurry Diagnosis of Ocular Syphilis","volume":"14","author":"Kiani","year":"2022","journal-title":"Cureus"},{"key":"2025082709302796000_17.9.e260588.3","doi-asserted-by":"crossref","first-page":"800383","DOI":"10.3389\/fmed.2022.800383","article-title":"An Updated Review of Recent Advances in Neurosyphilis","volume":"9","author":"Zhou","year":"2022","journal-title":"Front Med"},{"key":"2025082709302796000_17.9.e260588.4","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jocn.2019.08.033","article-title":"Neurosyphilis in the modern era: Literature review and case series","volume":"69","author":"Skalnaya","year":"2019","journal-title":"J Clin Neurosci"},{"key":"2025082709302796000_17.9.e260588.5","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jiac.2020.10.001","article-title":"Incidental finding of neurosyphilis with intracranial hemorrhage and cerebral infarction: A case report","volume":"27","author":"Imoto","year":"2021","journal-title":"J Infect Chemother"},{"key":"2025082709302796000_17.9.e260588.6","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.amjmed.2018.06.005","article-title":"Treatment of Syphilis-Associated Cerebral Vasculitis: Reappearance of an Old Question","volume":"131","author":"Mageau","year":"2018","journal-title":"Am J Med"},{"key":"2025082709302796000_17.9.e260588.7","doi-asserted-by":"publisher","DOI":"10.1080\/08820530500232092"},{"key":"2025082709302796000_17.9.e260588.8","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-30559-7","article-title":"Clinical Manifestations and Ophthalmic Outcomes of Ocular Syphilis at a Time of Re-Emergence of the Systemic Infection","volume":"8","author":"Furtado","year":"2018","journal-title":"Sci Rep"},{"key":"2025082709302796000_17.9.e260588.9","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2018-313207"},{"key":"2025082709302796000_17.9.e260588.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2014.10.030"},{"key":"2025082709302796000_17.9.e260588.11","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1001\/jamaophthalmol.2014.179","article-title":"A Complicated Case of Sarcoidosis","volume":"132","author":"Rescigno","year":"2014","journal-title":"JAMA Ophthalmol"},{"key":"2025082709302796000_17.9.e260588.12","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6543a2"},{"key":"2025082709302796000_17.9.e260588.13","unstructured":"Centers for Disease Control and Prevention (CDC) . 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