Sequential bilateral facial nerve palsy and gait ataxia – a rare presentation of neurosyphilis

A middle-aged gentleman presented with sequential bilateral facial nerve palsy and ataxia. A diagnostic workup revealed positive blood serology for active syphilis infection. Interestingly, his cerebrospinal fluid was negative for syphilis. The patient responded to treatment with benzylpenicillin and made a complete recovery. Unfortunately, the diagnosis of neurosyphilis ‘still’ poses a challenge to clinicians due to insufficient ‘sensitive’ testing modalities and diagnostic criteria. We highlight the need for a low threshold to test for syphilis in patients presenting with neurological sequelae whose diagnosis is not precise.