Early syphilitic meningoencephalitis masquerading as postclimacteric endogenous depression--a unique dermatologic presentation.

According to WHO, syphilis represents 3% of all sexually transmitted diseases. Additionally, the occurence of this disease has also been increasing in developed countries. The secondary stage of syphilis is characterized by a large variety of symptoms and may mimic many skin diseases. The generalized exanthem of the secondary stage is often confused with a drug eruption. The systemic involvement may also resemble other diseases. It is due to these peculiarities that syphilis, and in particular its secondary stage, is known in literature as the "clinical chameleon" or "great imitator". Nonspecific neurological symptoms like headache, lightheadedness, and slight mental depression appear prior to the skin manifestations characteristic of the second stage of the disease. Subsequently, when the patient begins to develop the characteristic disseminated maculopapular exanthem with palmoplantar involvement, the clinician may have to re-evaluate to exclude an early form of syphilitic meningoencephalitis. We report here the case of a female patient with suspected endogenous depression as part of the post-climacterium syndrome. Shortly after the introduction of antidepressant therapy the patient developed a generalized maculopapular exanthem. She was seen in the Dermatology clinic due to suspicion for a drug eruption. A diagnosis of secondary syphilis with palmoplantar involvement, associated with an early form of syphilitic meningoencephalitis, was established. After systemic antibiotic treatment, complete remission was achieved.