BIPOLAR DISORDER AS PSYCHIATRIC MANIFESTATION OF NEUROSYPHILIS

Abstract

Introduction: Syphilis is a sexually transmitted infection of great current relevance that can evolve with neuroinfection if not treated early. Clinical presentation may manifest with neurological and psychiatric conditions that mimic dementia, psychotic syndromes, and personality and mood disorders. Methodology: Search the Medline, Lilacs and PubMed databases using the neurosyphilis descriptors; Neurosyphilis; Bipolar Disorder; Bipolar Disorder. Case reports were selected, between 2011 and 2022, written in English, Portuguese and Spanish. Case report: A 42-year-old male patient without psychiatric comorbidities was admitted to the São Francisco University Hospital (HUSF) due to depressive symptoms. Five months ago, he had presented a maniform episode when a sea and cslefilet VDRL was performed, with a result of 1:128 and 1:64, respectively. He was diagnosed with neurosyphilis and was adequately treated for neuroinfection. At the time of the case, valproic acid was introduced 1g/day and, later, sertraline 50mg/day. In the HUSF, we chose to optimize the dose of medications already used, obtaining improvement of the clinical picture and without recurrences to date. Discussion: Neurosyphilis can mimetize bipolar disorder due to impairment of cognitive and executive functions in the pathophysiological process. The clinical evolution varies, and may be exuberant even after the appropriate treatment and the drop in VDRL titration. Conclusion: The diagnosis of neurosyphilis in psychiatric patients should always be suggested, since the disease can cause deficits and mood changes that can mimetize various neurological and psychiatric conditions.