Peripheral Facial Nerve Palsy as the Presenting Sign of Neurosyphilis: A Clinical Case

Case Presentation

The 63-year-old female presented to our outpatient clinic for further evaluation of tearing from the left eye that had been present for three days. The patient also reported that she was no longer able to completely close her left eye independently.

She was immediately referred to the neurology department for evaluation of a left-sided peripheral facial nerve palsy.

Laboratory tests showed a mildly elevated CRP level. A CT scan of the skull revealed no evidence of hemorrhage or infarction. The MEP findings indicated a complete intraosseous conduction block on the left with signs of axonal damage to the left facial nerve. Serological testing confirmed an infection with Treponema pallidum. Cerebrospinal fluid analysis showed no evidence of intrathecal disease activity.

Due to the presence of a sensory level below T6, spinal pain, and generalized skin changes consistent with the disease, intravenous antibiotic therapy with ceftriaxone was administered for a total of 14 days.

Because of incomplete eyelid closure, the patient was advised to wear an eye patch during the day and a moisture chamber dressing at night.

The cause of the syphilis infection was transmission from her husband, who had engaged in extramarital intercourse with a prostitute.

A serological follow-up two weeks after discharge remained positive; therefore, the patient was referred to the infectious diseases department. A notification form was submitted to the Robert Koch Institute (RKI).