Abstract Details

Title Neurosyphilis Masquerading as Longitudinally Extensive Transverse Myelitis and Radiculopathy with an Initially Remitting Course

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 084

Objective

To illustrate the clinical features, diagnostic challenges, and management considerations of neurosyphilis presenting as longitudinally extensive transverse myelitis (LETM).

Background Although neurosyphilis is most often a late clinical complication of treponemal infection, it can sometimes manifest early in the disease course, especially with concomitant HIV infection. The phenotype can vary significantly between patients, ranging from well-known entities such as meningitis to rare presentations such as LETM that can mimic other infectious, autoimmune, or neoplastic conditions.

Design/Methods We present the case of an uninsured 48-year-old man with symptoms suggestive of myeloradiculopathy. Clinical evaluation, imaging, serum, and CSF studies were utilized to establish the diagnosis. PubMed was utilized to review the relevant literature.

Results A few months following primary syphilitic lesion, rash, and uveitis, the patient developed gradual weakness and paresthesias in his lower extremities, complicated by falls. He had subjective improvement for three months, but due to acutely worsening weakness requiring a walker, he first presented to an ED where he underwent CT spine, which was unremarkable. He was discharged with symptomatic management but a week later presented with severe paraparesis, saddle anesthesia, urinary hesitancy, and erectile dysfunction. Spine MRI revealed prominent T2 hyperintense cord signal abnormalities extending from the medulla through the low thoracic spine with scattered hypointense foci concerning for intramedullary hemorrhages. Differential diagnoses included metastatic disease, demyelinating conditions, infections, and sarcoidosis. A broad workup showed positive serological and CSF tests for syphilis, which was highly suspected based on history. The patient was treated with penicillin but continued to experience significant weakness, requiring a wheelchair.

Conclusions Neurosyphilis is still a current cause of disability when untreated and must be considered in the differential diagnosis of myelopathy. Increased awareness and early recognition are crucial to prevent long-term disability and improve patient outcomes, especially in underserved populations with limited healthcare resources.

Authors/Disclosures
Christine Petit-Frere, MD PRESENTER	Ms. Petit-Frere has nothing to disclose.
Samuele Bonomi, MD (Washington University in St Louis, Department of Neurology)	Dr. Bonomi has nothing to disclose.
Amjad Samara, MD	Dr. Samara has nothing to disclose.
Muhammad Al-Lozi, MD (Washington University in Saint Louis)	Dr. Al-Lozi has nothing to disclose.
Enmanuel Perez, MD, PhD (Department of Neurology, Washington University School of Medicine in St. Louis)	Dr. Perez has nothing to disclose.

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