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Late neurosyphilis and VZV meningoencephalitis coinfection
  1. Kristin Carr and
  2. Onyema Ogbuagu
  1. Infectious Diseases, Yale-New Haven Hospital, New Haven, Connecticut, USA
  1. Correspondence to Dr Kristin Carr; krcarr{at}


The incidence of syphilis has increasing recently, largely attributable to improved screening that may result in the diagnosis of chronic untreated infections. These patients can develop severe or subtle neurologic symptoms that can be missed and, therefore, detected accidentally while a patient is evaluated for other mimicking neurological infections. A 58-year-old man with diabetes presented with 2 days of aphasia, headache, chills and confusion. He had an MRI brain with evidence of a prior cerebrovascular accident. Subsequently, he developed a fever and thoracic dermatomal rash consistent with herpes zoster. A lumbar puncture was performed, and cerebrospinal fluid analysis revealed a lymphocytic pleocytosis, a reactive Venereal Disease Research Laboratory test and positive varicella-zoster virus (VZV) PCR. He was suspected to have both late neurosyphilis and acute meningoencephalitis from VZV. This paper will discuss how to approach the diagnosis of late neurosyphilis and possible associations with herpesvirus central nervous system infections.

  • syphilis
  • meningitis
  • infection (neurology)

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  • Contributors KC provided the concept and design, drafted the report, acquired the patient information, revised the article for critical intellectual content and provided final approval for submission of the manuscript. OO contributed to the idea for the article, made critical revisions of the article which contributed to the final content, and then gave final approval of the version submitted. Both authors are accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.