A patient presenting with early syphilis and features of general paralysis of insane - An interesting case report in the 21 century!

A 66-year-old unemployed unmarried male with known men sex men activity since the age of 20 years presented with an erythematous well-defined ulcer on the lower lip and multiple discrete papulo-squamous lesions on the palms, soles, and scrotum. The patient was also in dysphoric mood with grandiose ideas with normal higher function. Knee and ankle jerk reflexes were absent and there was impaired tandem walking. Venereal Disease Research Laboratory (VDRL) and treponema pallidum hemagglutination assay were positive. Cerebrospinal fluid-VDRL was positive with grossly elevated proteins and glucose. HIV test was negative. Magnetic resonance imaging scan of the brain was normal. We made a diagnosis of neurosphilis - General paralysis of insane (GPI) with co-existing early syphilis. The patient was started on crystalline penicillin for 14 days after which there was significant improvement in behavior. We are reporting a rare case of GPI with early syphilis.