Neurosyphilis manifesting as lightning pain.

The large scale use of antibiotics in recent years has changed the face of neurosyphilis, as it has been accompanied by a drop in incidence and frequent replacement of typical forms of presentation with atypical or masked forms. Herein, we describe three patients who presented initially with intermittent stabbing, or lightning-like pains in the extremities that lasted for several years, who were subsequently diagnosed as having neurosyphilis during a clinical evaluation. The clinical symptoms underlying neurosyphilis are complex, rendering diagnosis and treatment difficult. Therefore clinicians must learn to recognize these symptoms to improve patient outcomes.