An Immunocompromised Individual Presenting with two Unlikely Combinations: An Infectious and Autoimmune Disease
Marjorie Ho1, Harini Gali1, Seulgi Choi2
1Neurology, Texas Tech University Health Sciences Center, 2Texas Tech University Health Science Center
Objective:
Neurosyphilis is often termed as a great imitator due to its varied manifestations making it important to rule out other conditions. Acute inflammatory polyradiculopathy (AIDP) and Chronic inflammatory demyelinating polyneuropathy (CIDP)are one of them. Here we present a unique case of a dual diagnosis of Neurosyphilis and CIDP.
Results:
A 49-year-old male with HIV developed AIDP in 2012 after a flu shot. He was then treated with (intravenous immunoglobulin) IVIg with subsequent recovery. In 2016 , he presented with progressive distal weakness and numbness of all limbs with areflexia. The patient was not compliant with his anti-retroviral therapy (ART). CD4 count was 11 with a viral load 200,000. Imaging unremarkable. CSF showed albuminocytologic dissociation, streptococcus mitis, VDRL negative, FTA-ABS reactive, VZV negative, HSV 1&2 DNA negative. Nerve conduction study (NCS) revealed chronic demyelinating polyradioculoneuropathy and was subsequently diagnosed with CIDP. Later, ART was resumed along with monthly IVIg with clinical improvement. In 2021, the patient was seen again by Neurology for complaints of intermittent numbness of right arm and leg. NCS showed mixed axonal and demyelinating neuropathy, stable CIDP, however improved when compared to 2016. He presented again in 2025 for fall and paraparesis during which he was treated for secondary syphilis with Penicillin G for 14 days, IVIg for 5 days in view of history of CIDP and daptomycin for 8 weeks as patient was found to have spinal abscess on MRI imaging with significant improvement.
Conclusions:
The patient's clinical manifestation, course and investigations support a dual diagnosis of neurosyphilis and CIDP. These could be separate entities in the setting of immunocompromised, or perhaps neuroinflammation secondary to Syphilitic infection led to demyelination resulting in CIDP. This is a rare scenario with only one other published case. Neurosyphilis should be considered in an immunocompromised patients with CIDP.
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