A case of neurosyphilis with multiple cranial neuropathies in an immunocompetent patient

A 65‐year‐old man presented to the emergency department with right facial weakness and transient dysphagia. He had no past medical history of note, including no history of opportunistic infection. He was in a monogamous relationship with his male partner over the past 2 years and had engaged in regular unprotected sexual intercourse. In the 5 weeks prior to presentation, he had also developed diffuse left‐sided facial pain, affecting all three branches (V1–V3) of the trigeminal nerve. Examination was in keeping with right lower motor neuron facial nerve palsy with right‐sided hypoesthesia in the V3 distribution. There were no meningeal signs. Three weeks later, he subsequently reported a transient 24‐hour episode of vertigo. Repeat examination was unremarkable apart from an improving residual right facial asymmetry. There was no suggestion of optic nerve involvement based on history or examination findings, including fundoscopy.