LETTERS A Case of Neurosyphilis Presenting With Dementia and Psychiatric Symptoms

a clinical type of tertiary syphilis with invasion of central nervous system. It can imitate psychiatric disorders such as mood disorders, psychosis, and dementia.1 There are a few cases of neurosyphilis with dementia that were reported previously.2–4 Here, we report on a patient who was first diagnosed with frontotemporal dementia, but who was finally shown to have neurosyphilis. Case Report A 49-year-old man without a family history of psychiatric or neurologic illness was referred to our psychiatry clinic because of memory impair-ment, speech disturbance, ag-gressiveness, insomnia, suicidal behaviors, self-mutilation, apathy, hyperphagia, disorganized behav-iors such as undressing and urinating in improper places within the last 2 years. Lately, he became dependent on caregivers and could not run his transporting business. A year ago, before his hospitalization, he was referred to an outpatient neurology clinic and diagnosed by cranial magnetic resonance imaging (MRI) with frontotemporal dementia (find-ings of hyperintense signal changes on both mesial temporal lobes [Figure 1]). Because there was no improvement in his clinical status after paroxetine 20 mg/day and risperidone 1mg/day treatment, and because of increased behavioral changes and a suicidal attempt, the patient was hospitalized. He was apathetic and uncooperative durin