Abstract / Summary
Abstract Neurosyphilis is an infectious disease of the central nervous system caused by Treponema pallidum. Its incidence has been increasing globally. Due to variable clinical presentations, nonspecific symptoms, and diverse latency periods, neurosyphilis is frequently misdiagnosed or missed altogether. It commonly involves a single cranial nerve.We report a rare case of neurosyphilis presenting with multiple cranial nerve involvement as the initial manifestation. The patient was admitted with progressive cranial neuropathies. Comprehensive evaluations, including serologic tests, cerebrospinal fluid (CSF) analysis, and cranial MRI, were conducted. Laboratory findings supported the diagnosis of neurosyphilis, with positive serum and CSF Treponema pallidum antibodies, CSF pleocytosis, and elevated protein levels. MRI revealed abnormal enhancement of multiple cranial nerves. The patient was treated with high-dose intravenous penicillin, resulting in gradual clinical improvement.This case highlights the diagnostic challenges posed by atypical neurosyphilis presentations. By reviewing this rare case and relevant literature, we aim to improve clinicians' awareness of neurosyphilis with polycranial neuritis and promote timely diagnosis and effective treatment.