SYPHILITIC MYELITIS: RARE, NONSPECIFIC, BUT TREATABLE

Abstract

Syphilis outbreaks have re-emerged throughout the world, particularly among homosexual men.1 Syphilitic myelitis is a rare manifestation of syphilis and a rare cause of myelopathic syndromes in general. We report a patient with complete clinical and radiologic recovery following treatment. As the clinical presentation was nonspecific, only serologic testing revealed the diagnosis. ### Case report. A 46-year-old man was admitted with a 7-day history of progressive genital and sacral numbness, pain in the groin, without motor or autonomic dysfunction. Examination documented hypoalgesia and thermhypesthesia, normal sphincter tone, and pyramidal signs with hyperreflexia of the legs. Spinal MRI revealed swelling and high signal intensity of the central portion of the spinal cord parenchyma below T6 on T2-weighted images and two focal gadolinium enhancements (figure). Brain MRI was normal. CSF examination showed 113 mononuclear cells/μL, 0.72 g/L protein, and normal glucose and lactate levels. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, and rheumatic factor were negative. The Treponema pallidum hemagglutination test and the Venereal Disease Research Laboratory (VDRL) test were positive with 1:81,920 (<1:80) and 1:64 (<1:2). A positive intrathecal Treponema pallidum antibody (iTPA) index confirmed neurosyphilis. Active HIV, herpes, human T-cell lymphotrophic virus, Mycoplasma pneumoniae , Schistosoma , or …