Neuromyelitis Optica Spectrum Disorder and Neurosyphilis Coexist in A Chinese Woman

Fulan Shan Youming Long

doi:10.4172/2155-9929.1000198

Abstract

Background: Neuromyelitisoptica spectrum disorder (NMOSD) is a series of central nervous system diseases with positive aquaporin-4 antibody. And neurosyphilis is a manifestation of the late syphilis. Although Neuromyelitisoptica (NMO) following syphilis has been previously reported, transverse myelitis and neurosyphilis in the same patient with positive aquaporin-4 antibody has never been mentioned. Method: We presented the coexistence of NMOSD and syphilis in a 72-year-oldChinese woman and analyzed the relationship of these two diseases. The pertinent literatures were also reviewed. Result: Previous studies showed that syphilitic myelitis might be more frequent in male than in female and it tended to be asymptomatic. However our case was a woman who experienced acute attack, with positive AQP4 antibody. Therefore, her myelitis occurrence mainly associated with AQP4 antibodies autoimmunity, and neurosyphilis might be an asymptomatic episode in our case. Although there was no evidence that treponema pallidum subspecies pallidum involved in the pathogenesis of NMO, it seemed that anti-syphilitic treatment was helpful to attenuate disability in our present case. Conclusion: Anti-NMO and anti-syphilitic treatment should be used together to treat the patient with both NMOSD and neurosyphilis.

Highlights

Transverse myelitis (TM) is an inflammatory demyelinating disorder of the spinal cord that has various manifestations [1]
TM has several subtypes according to origin but, in China, most of them are associated with neuromyelitisoptica (NMO) and multiple sclerosis (MS) [1]
NMO immunoglobulin G (IgG), selectively targeting to the antigen of aquaporin-4 (AQP4) that localizes in the central nervous system (CNS) microvessels, pia, subpia, and Virchow-Robin space has been considered as an biomarker to some TM [2], which is defined as NMO spectrum disorder (NMOSD)

Summary

Result

Previous studies showed that syphilitic myelitis might be more frequent in male than in female and it tended to be asymptomatic. Our case was a woman who experienced acute attack, with positive AQP4 antibody. Her myelitis occurrence mainly associated with AQP4 antibodies autoimmunity, and neurosyphilis might be an asymptomatic episode in our case. There was no evidence that treponema pallidum subspecies pallidum involved in the pathogenesis of NMO, it seemed that anti-syphilitic treatment was helpful to attenuate disability in our present case

Introduction

Discussion