Syphilitic Meningomyelitis

Gilbert Siu

doi:10.7556/jaoa.2017.130

Article Open Access

Syphilitic Meningomyelitis

Gilbert Siu

Published/Copyright: October 1, 2017

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Osteopathic Medicine Volume 117 Issue 10

Keywords: HIV; syphilitic meningomyelitis

A 41-year-old man with a 10-year history of HIV was admitted to the hospital after he was found unconscious in his home. His current medication included antiretroviral therapy. Upon awakening, the patient was weak and reported numbness in his upper and lower limbs. Manual muscle testing demonstrated upper and lower limb weakness with decreased sensation to light touch and pinprick below the C5 level. A magnetic resonance image of the spine demonstrated spinal cord edema at C3 through T1 levels, with focal spinal cord enhancement at C6, without spinal cord atrophy (image A and image B, arrows). Rapid plasma reagin, Treponema pallidum hemagglutination assay, and cerebrospinal fluid (CSF) VDRL test results were positive, and syphilitic meningomyelitis was diagnosed. Penicillin G was administered intravenously (24 million U/d for 14 days). Symptoms began to improve after 1 week, and the patient was discharged.

Syphilitic meningomyelitis represents less than 3% of neurosyphilitic cases.¹ The diagnosis is based on a high CSF white blood cell count (≥20 µL) with either a reactive CSF VDRL test result or a positive CSF intrathecal T pallidum antibody index.¹ In syphilitic meningomyelitis, magnetic resonance imaging of the spinal cord demonstrates centrally long-segment diffuse high-intensity abnormality on T2-weighted images, in contrast to tabes dorsalis, in which the dorsal column would be affected.^2-4 The recommended treatment for patients with syphilitic meningomyelitis is 18 to 24 million U/d of intravenous, aqueous penicillin G for 10 to 14 days.⁵

Financial Disclosures: None reported.

Support: None reported.

^*Address correspondence to Gilbert Siu, DO, PhD, Director of Brain Injury and Stroke Rehabilitation, HealthSound Hospital of Vineland, 1237 W Sherman Ave, Vineland, NJ 08360-6920. E-mail: gilbert.siu@gmail.com

References

1. Chilver-Stainer L , FischerU, HaufM, FuxCA, SturzeneggerM. Syphilitic myelitis: rare, nonspecific, but treatable. Neurology. 2009;72(7):673-675.10.1212/01.wnl.0000342460.07764.5cSearch in Google Scholar PubMed

2. Pandey S . Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. J Spinal Cord Med. 2011;34(6):609-611. doi:10.1179/2045772311Y.0000000041Search in Google Scholar

3. He D , JiangB. Syphilitic myelitis: magnetic resonance imaging features. Neurol India. 2014;62(1):89-91.10.4103/0028-3886.128347Search in Google Scholar PubMed

4. Kikuchi S , ShinpoK, NiinoM, TashiroK. Subacute syphilitic meningomyelitis with characteristic spinal MRI findings. J Neurol. 2003;250(1):106-107.10.1007/s00415-003-0921-7Search in Google Scholar PubMed

5. Ghanem KG . Management of adult syphilis: key questions to inform the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2015;61(suppl 8):S818-S836.10.1093/cid/civ714Search in Google Scholar PubMed

Received: 2017-04-22

Accepted: 2017-04-27

Published Online: 2017-10-01

Published in Print: 2017-10-01

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in the same Issue

https://doi.org/10.7556/jaoa.2017.130

Keywords for this article

HIV; syphilitic meningomyelitis

Creative Commons

BY-NC-ND 4.0