Unveiling the Diagnostic and Therapeutic Challenges: A Singular Case of Syphilitic Myelitis in an HIV-positive Patient
Zaka Ahmed1, Talha Nazir3, Safia Mohamud2, Mosunmola Oyawusi4, Roger Weir2
1Neurology, Howard University Hospital, 2Howard University Hospital, 3Neurocare.AI, 4Howard University College of Medicine
Objective:
To illustrate the diagnostic challenges and treatment response in a rare case of syphilitic myelitis affecting an immunocompromised patient with HIV, with an aim to underscore the necessity for a comprehensive neurological evaluation and syphilis screening in similar clinical settings.
Background:
Syphilitic myelitis is a rare form of neurosyphilis caused by Treponema Pallidum. With only 20 cases reported from 1987 to 2018, it primarily affects the spinal cord and is diagnosed through specific CSF markers like VDRL and FTA-ABS. This condition is especially prevalent among immunocompromised individuals, including those with HIV. Diagnostic clues on MRI feature diffuse hyperintensity and other unique signs, while cervical involvement is notably rare
Design/Methods:
We report a case of a 51-year-old HIV-positive male presenting with lower limb weakness, sensory changes, and urinary issues. Neurological exams revealed hyperreflexia and positive clonus in the right foot. Spinal MRI showed bilateral lamina fractures and elevated T2 signals, consistent with transverse myelitis. CSF analysis confirmed syphilitic myelitis, and the patient responded well to a 15-day IV penicillin course before discharge.
Conclusions:
In conclusion, this case serves as a compelling testament to the indispensability of meticulous medical history-taking and targeted syphilis screening, especially in immunocompromised individuals presenting with neurological disturbances. Rigorous diagnostic protocols, involving MRI, CSF analysis, and serum antibody tests, are pivotal for accurate case identification. The effectiveness of intravenous penicillin as the treatment regimen of choice is also underscored, attesting to its pivotal role in patient recovery. Given the rarity and diagnostic intricacies of syphilitic myelitis, this case significantly contributes to the existing body of literature and underscores the need for heightened clinical vigilance in similar patient populations