Neurosyphilis Presenting as Intermittent Explosive Disorder and Acute Psychosis

We present a case of a patient with tertiary syphilis, manifesting as acute psychosis, auditory hallucinations and intermittent explosive disorder with pending legal ramifications for physical violence. Our patient had been seen and treated by a psychologist with Aripiprazole for his erratic and aggressive behavior coupled with his new found psychosis over a one-year period with no avail. Prior accounts of interaction with the patient described him as “easy going”, “laid back”, and cooperative. Our patient had a complete return to baseline mentation and functionality post treatment with 4 Million Units every four hours of penicillin for two weeks. Neurosyphilis is a disease that greatly affects the mental functioning capacity of those infected. While treatment of syphilis has become greatly straightforward, those living in impoverished conditions and without a continual access to the health care system can progress through the stages of syphilis. It is of vital importance to keep syphilis on our differential for patients with rapidly progressing and broadly encompassing psychiatric disturbances especially in patients that have a lower socioeconomic status.