Seo Eun Hyun, Yang Hae Jung, Kim Sang Hoon, Park Jung Hyun, Yoon Hyung-Jun
1Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea.
Department of Psychiatry, Chosun University Hospital, Chosun University, Gwangju, Republic of Korea.
Ann Gen Psychiatry. 2018 Jun 6;17:24. doi: 10.1186/s12991-018-0195-1. eCollection 2018.
Neurosyphilis remains a diagnostic challenge in current psychiatric practice because of its pleomorphic psychiatric manifestations. Although neurosyphilis can present with a wide range of psychiatric symptoms, psychotic mania as its solitary manifestation is an unusual phenomenon.
A 46-year-old man, with no history of any psychiatric disorder, exhibited abruptly developed symptoms of psychotic mania. He was admitted to a psychiatric ward for further evaluation and treatment. Upon admission, his cognitive function was unimpaired, and the hyperactivity was not severe. Also, no abnormalities were found upon neurological examination and brain magnetic resonance imaging. He was initially diagnosed as bipolar disorder with psychotic features. On the 3rd day after admission, he was confirmed as having neurosyphilis by analysis of cerebrospinal fluid and treated with intravenous penicillin-in combination with blonanserin-an atypical antipsychotic drug. After 2 weeks of treatment, most of the symptoms had abated.
The present case emphasizes that patients presenting with atypical psychiatric manifestation should be screened for possible syphilis, particularly in the absence of previous psychiatric history, and suggests that combination of blonanserin with antibiotic therapy may be effective in the treatment of the manic and psychotic symptoms secondary to neurosyphilis.
由于神经梅毒具有多形性精神症状，在当前精神科实践中仍是一个诊断难题。虽然神经梅毒可表现出广泛的精神症状，但以精神病性躁狂作为唯一表现是一种不寻常的现象。
一名46岁男性，既往无任何精神疾病史，突然出现精神病性躁狂症状。他被收治入精神科病房进行进一步评估和治疗。入院时，他的认知功能未受损，多动症状也不严重。此外，神经科检查和脑磁共振成像均未发现异常。他最初被诊断为伴有精神病性特征的双相情感障碍。入院后第3天，通过脑脊液分析确诊为神经梅毒，并接受静脉注射青霉素联合非典型抗精神病药物布南色林治疗。治疗2周后，大部分症状减轻。
本病例强调，对于出现非典型精神症状的患者，尤其是既往无精神病史的患者，应筛查是否可能患有梅毒，并提示布南色林与抗生素联合治疗可能有效治疗神经梅毒继发的躁狂和精神病性症状。
