A 40-year-old woman presented via ambulance to our Emergency Department (ED) for decreased level of consciousness. The patient's husband reported declining cognitive ability over the prior 3 months, and a hospital visit for left leg weakness 5 months earlier. In the ED, the patient exhibited recurrent opisthotonus episodes. Old records obtained from another hospital were positive for reactive rapid plasma reagin test and florescent treponemal antibody absorption test (FTA-ABS). The patient's husband confirmed exposure to syphilis 15 years earlier. Subsequently, during hospitalization, the patient had a positive cerebrospinal fluid venereal disease research laboratory test and FTA-ABS, visible changes on a brain magnetic resonance imaging study, and was diagnosed with neurosyphilis.
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