Itchy rash uncovers rare syphilis with neurosyphilis in an elderly man
An 83-year-old man in Belgium presented with facial nerve palsy, fever, anemia, and liver/kidney abnormalities. A severely itchy rash prompted testing that revealed Treponema pallidum infection, leading to a diagnosis of secondary syphilis with early neurosyphilis. He was treated with a 14‑day IV penicillin course, after an initial injection, with improvement and normalization of labs. The case highlights atypical, multisystem presentation of syphilis (including potential latent reactivation) and CNS involvement; public health authorities and his wife were notified/tested.
