Neurosyphilis-related myelitis

Area of Science:

• Neurology
• Infectious Diseases
• Spinal Cord Medicine

Background:

• Syphilis is a complex infectious disease with diverse neurological manifestations.
• Myelitis is an uncommon but serious neurological complication of syphilis.
• Hyperacute cord syndromes require rapid diagnosis and intervention.

Purpose of the Study:

• To report a rare case of neurosyphilis presenting as myelitis.
• To highlight the diagnostic challenges and clinical features of syphilitic myelitis.
• To emphasize the importance of considering neurosyphilis in acute myelopathy.

Main Methods:

• Case report of a 29-year-old male with sudden onset paraplegia.
• Clinical examination revealed flaccid paraplegia with a specific sensory level.
• Spinal MRI demonstrated longitudinally extensive myelitis with characteristic imaging findings.
• Diagnostic confirmation through positive syphilis serology in serum and cerebrospinal fluid.

Main Results:

• The patient presented with sudden bilateral leg weakness, back pain, and urinary retention.
• Spinal MRI revealed longitudinally extensive myelitis with 'candle guttering' and 'flip-flop' signs.
• Syphilis serology was positive in both serum and cerebrospinal fluid.
• A dramatic and sustained response to corticosteroids and antimicrobial therapy was observed.

Conclusions:

• Neurosyphilis should be considered in the differential diagnosis of hyperacute myelitis.
• Early diagnosis and treatment are crucial for favorable outcomes in syphilitic myelitis.
• The characteristic MRI findings can aid in the diagnosis of this rare condition.