Medical case narrative
A 15-year-old whose "mental illness" was an infection with a test
What happened
A 15-year-old girl in Chengdu, China (unnamed in the published report), became ill in October 2011: increasingly nervous, talking less, restless, with whole-body tremors, unable to care for herself or bathe. At her local hospital she was first diagnosed with viral encephalitis and treated briefly. She was then transferred to a local mental hospital, where an MRI showed mild brain atrophy and she was prescribed sulpiride up to 1.2 g/day and benzhexol up to 8 mg/day. Her condition did not improve, and her tremors became increasingly severe — roughly three months under wrong labels before the cause was found. Sensitivity note, printed once and plainly: she was a minor, and the history that explained her exposure — an assault in 2009 — was disclosed by her mother only after the positive test came back, which is why the risk had stayed hidden for two years. Nothing beyond what the published report contains is added here.
What it looked like
Visual hallucinations, persecutory delusions, flattening of affect, poverty of thought, restlessness and pacing — and a movement disorder managed as mental illness: tremors throughout her body and four-limb rigidity, a Parkinsonism picture, in a 15-year-old.
What the labs found
On admission all antipsychotics were stopped and a neurologist consulted; serology for rare causes was ordered. Her serum tests came back positive for syphilis: a TRUST titre of 1:4, a positive T. pallidum antibody test. Lumbar puncture confirmed neurosyphilis — spinal-fluid VDRL reactive at 1:2, with raised cells and proteins. Her baseline scores were a PANSS of 115 and a Parkinsonism rating (UPDRS) of 129.
What changed
Penicillin — 3 million units every four hours for fourteen days, plus benzathine penicillin weekly for three weeks — and no antipsychotic after admission. At three months her tremors and limb rigidity were relieved, hallucinations and delusions were gone, and her scores had fallen to a PANSS of 39 and a UPDRS of 32: dramatic improvements that are not a return to baseline — residual symptoms remained, and this entry does not write a complete recovery. One attribution caution, which the authors themselves raise: the antipsychotics were stopped partly to exclude drug-induced movement effects, and a drug contribution to the Parkinsonism cannot be fully excluded from the record — though the Parkinsonism had worsened on sulpiride and resolved after it was stopped and penicillin given.
The test that told the story
Syphilis serology (serum VDRL/TRUST), confirmed by spinal-fluid VDRL — ordered only when someone stopped and asked about rare causes.
Sources: Yin, Zou & Huang 2015 (primary case report, all values); a 2025 paper on an adolescent dementia case whose differential-diagnosis discussion describes this same patient ("a 15-year-old girl and rape victim with neurosyphilis who presented with marked psychotic features and Parkinsonism").