{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:38:13Z","timestamp":1790699893521,"version":"4.1.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Neurosyphilis may manifest in a form resembling autoimmune encephalitis, primarily characterized by cognitive impairment, psychiatric disorders, and seizures. Brain magnetic resonance imaging typically reveals unilateral or bilateral lesions in the mesiotemporal lobe and may also identify abnormalities in the inferior frontal lobe, parietal lobe, occipital lobe, and thalamus. Nevertheless, there are very few reports addressing this particular aspect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective review of the medical records of inpatients diagnosed with neurosyphilis who presented with cognitive impairment, psychiatric disorders, and seizures. All patients underwent lumbar puncture and cerebrospinal fluid (CSF) examination. A total of nine inpatients were consecutively enrolled from Beijing Ditan Hospital between July 2019 and December 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven patients were male, while two patients were female. All patients presented with acute or subacute onset and had no fever prior to the onset. Four patients presented with seizures, two exhibited psychiatric and behavioral abnormalities, and three experienced memory decline. Throughout the course of the disease, a total of seven patients presented seizures. In the physical examination, all patients exhibited cognitive impairment. Regarding the CSF analysis, the initial results for one patient were inconclusive. The remaining patients demonstrated lymphocyte-predominant pleocytosis along with elevated CSF protein concentrations. One patient tested positive for the anti-CV2\/CRMP5 antibody in both serum and CSF. Magnetic resonance imaging of the brain revealed that eight patients had sustained damage to the mesiotemporal lobe, while one patient demonstrated damage exclusively to the bilateral frontal and occipital lobes. Five patients exhibited sharp waves or sharp-slow waves on their electroencephalograms. All patients showed improvement in symptoms after antisyphilitic treatment for neurosyphilis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Neurosyphilis may manifest with symptoms associated with the limbic system, and brain magnetic resonance imaging often reveals unilateral or bilateral lesions in the mesiotemporal lobe that resemble those seen in autoimmune encephalitis. Early intervention with antisyphilitic treatment has proven to be effective. Clinicians should remain vigilant for such atypical presentations of neurosyphilis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1603596","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T05:21:51Z","timestamp":1750742511000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["A retrospective review of nine cases of atypical neurosyphilis"],"prefix":"10.3389","volume":"12","author":[{"given":"Ran","family":"Miao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Canglin","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyang","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuming","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1056\/NEJMra1906228","article-title":"Neurosyphilis","volume":"381","author":"Ropper","year":"2019","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s10072-017-3109-0","article-title":"Mesial encephalitis: an uncommon presentation of neurosyphilis: a case report and review of the literature","volume":"39","author":"Serrano-Cardenas","year":"2018","journal-title":"Neurol Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e188","DOI":"10.1212\/WNL.0000000000001033","article-title":"Clinical reasoning: the \u201cgreat imitator\u201d","volume":"83","author":"Karsan","year":"2014","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s10072-011-0563-y","article-title":"Neurosyphilis presenting with psychotic symptoms and status epilepticus","volume":"33","author":"Yao","year":"2012","journal-title":"Neurol Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"E962","DOI":"10.1503\/cmaj.170190","article-title":"Neurosyphilis mimicking autoimmune encephalitis in a 52-year-old man","volume":"189","author":"Budhram","year":"2017","journal-title":"CMAJ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e002204","DOI":"10.1136\/bmjopen-2012-002204","article-title":"Comparing the performance characteristics of CSF-TRUST and CSF-VDRL for syphilis: a cross-sectional study","volume":"3","author":"Gu","year":"2013","journal-title":"BMJ Open"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1128\/JCM.02522-13","article-title":"Comparison of the cerebrospinal fluid (CSF) toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China","volume":"52","author":"Zhu","year":"2014","journal-title":"J Clin Microbiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/jdv.16946","article-title":"2020 European guideline on the management of syphilis","volume":"35","author":"Janier","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.annemergmed.2015.07.526","article-title":"Sexually transmitted diseases treatment guidelines, 2015","volume":"64","author":"Workowski","year":"2015","journal-title":"MMWR Recomm Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/S1474-4422(15)00401-9","article-title":"A clinical approach to diagnosis of autoimmune encephalitis","volume":"15","author":"Graus","year":"2016","journal-title":"Lancet Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/S1474-4422(13)70282-5","article-title":"Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study","volume":"13","author":"Gresa-Arribas","year":"2014","journal-title":"Lancet Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e1014","DOI":"10.1212\/NXI.0000000000001014","article-title":"Updated diagnostic criteria for paraneoplastic neurologic syndromes","volume":"8","author":"Graus","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.4103\/1673-5374.371400","article-title":"An overview on CV2\/CRMP5 antibody-associated paraneoplastic neurological syndromes","volume":"18","author":"Wang","year":"2023","journal-title":"Neural Regen Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"285","DOI":"10.2174\/1573405617666210712130555","article-title":"T2\/FLAIR Hyperintensity in mesial temporal lobe: challenging differential diagnosis","volume":"18","author":"Moon","year":"2022","journal-title":"Curr Med Imaging"},{"key":"ref15","first-page":"314","article-title":"Mesiotemporal T2-weighted hyperintensity: neurosyphilis mimicking herpes encephalitis","volume":"22","author":"Bash","year":"2001","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1136\/jnnp.2003.022285","article-title":"Neurosyphilis with complex partial status epilepticus and mesiotemporal MRI abnormalities mimicking herpes simplex encephalitis","volume":"75","author":"Marano","year":"2004","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"208","DOI":"10.29819\/ANT.200512.0007","article-title":"General paresis with reversible mesial temporal T2-weighted hyperintensity on magnetic resonance image: a case report","volume":"14","author":"Chen","year":"2005","journal-title":"Acta Neurol Taiwanica"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1603596\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T05:21:52Z","timestamp":1750742512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1603596\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":17,"alternative-id":["10.3389\/fmed.2025.1603596"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1603596","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]},"article-number":"1603596"}}