Uncertain source of rare syphilis case sparks diagnostic dilemma
An 83-year-old man in Belgium presented with facial palsy and systemic symptoms; weeks in hospital revealed anemia, liver abnormalities, edema, and kidney dysfunction. A positive Treponema pallidum test and elevated white blood cells in cerebrospinal fluid led to a diagnosis of secondary syphilis with early neurosyphilis—an unusual presentation with an uncertain infection source, possibly a latent infection reactivation or a recent exposure. He received penicillin therapy and improved, highlighting the diagnostic challenge in atypical syphilis cases.