Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review

Infectious diseases of immigrant populations have recently become important issues for the health of both Korean nationals and foreigners living in Korea. This case report of general paresis is intended to raise awareness about re-emerging neurosyphilis in Korea as a possible etiology of psychotic disorders. A 68-year-old male Chinese resident came to Korea in 2019 with disorientation, auditory hallucination, persecutory delusion, and aggressive behavior, and was admitted to a psychiatric ward for further evaluation and treatment via the emergency department. He was confirmed to have neurosyphilis by serum test, analysis of cerebrospinal fluid, and brain magnetic resonance imaging. After treatment with antibiotics, including intravenous penicillin, in combination with atypical antipsychotics for 6 weeks, his disorientation, auditory hallucination, delusion, and aggressive behavior had attenuated. Neurosyphilis should still be included as a possible etiology of psychotic disorders in Korea. At the initial evaluation, syphilis screening serum tests are recommended for psychotic patients, especially those with pleomorphic symptoms and cognitive dysfunction.