Unveiling the Diagnostic and Therapeutic Challenges: A Singular Case of Syphilitic Myelitis in an HIV-Positive Patient
Unzela Rahmatullah1, Zaka Ahmed2, Fathi Massoud Marei Abokalawa3, Safia Mohamud3, Mosunmola Oyawusi4, Roger L. Weir3
1Neurology, Howard university hospital, 2Neurology, Howard University Hospital, 3Howard University Hospital, 4Howard University College of Medicine
Objective:
To present a rare case of syphilitic myelitis in an HIV-positive patient, emphasizing diagnostic challenges, MRI findings, and treatment outcomes. This case underscores the importance of considering syphilitic myelitis in immunocompromised patients with neurological symptoms.
Background:
Syphilitic myelitis, a rare condition caused by Treponema pallidum, primarily affects immunocompromised individuals, especially those with HIV. This uncommon form of neurosyphilis impacts only the spinal cord and is diagnosed through CSF VDRL or FTA-ABS tests. A 2019 review found only 20 cases from 1987-2018, underscoring its rarity. MRI scans often show distinctive features like diffuse hyperintensity, flipflop sign, wedge-shaped enhancement, candle guttering, and spinal cord swelling. Cervical spinal cord involvement is particularly uncommon, further highlighting the condition's unique presentation.
Design/Methods:
We examined a 51-year-old HIV-positive man with leg weakness, numbness, vision changes, and urinary issues. His exam showed right patellar hyperreflexia, clonus, and positive Babinski sign. Brain MRI was normal, but spine MRI revealed lamina papyracea fractures and increased T2 signal in thoracic and cervical regions. CSF analysis showed reactive VDRL, hypoglycemia, high protein, and lymphocyte predominance, suggesting syphilitic myelitis. After 15 days of IV penicillin treatment, the patient improved and was discharged.
Conclusions:
This case highlights why it's crucial to dig into medical histories and screen for syphilis in patients with weakened immune systems who show up with nerve-related symptoms. To nail down the diagnosis, doctors should use a combination of MRI scans, spinal fluid tests, and blood antibody checks. When it comes to treatment, good old penicillin still leads the pack as the go-to medicine for these tricky cases. By sharing this patient's story, we hope to remind our colleagues to keep syphilitic myelitis on their radar, especially when dealing with folks who have compromised immune systems.
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