Abstract
Background
Syphilis is a sexually transmitted infection that was nearly eradicated in 2001 but
is now making a resurgence. It has a wide range of clinical manifestations depending
on disease stage. Neurosyphilis is an infrequently seen infectious disease with central
nervous system involvement that can occur in either early- or late-stage syphilis.
The diagnosis of neurosyphilis is challenging, primarily because Treponema pallidum, the infecting organism, cannot be cultured in vitro. This article describes a patient
with neurosyphilis and reviews the epidemiology and clinical manifestations, diagnostics,
and treatment of neurosyphilis.
Case Report
In compliance with the request of the Privacy Board of our institution, the numerical
age of this patient has been omitted. A sexually active teenage girl who was treated
for primary syphilis 2 years earlier presented to a tertiary children's hospital with
paresthesia and weakness of her right leg, left arm, and neck. Magnetic resonance
imaging revealed cervical intramedullary cord edema consistent with transverse myelitis.
Serum studies showed positive syphilis enzyme immunoassay, T. pallidum particle agglutination assay, and fluorescent treponemal antibody absorption. A serum
rapid plasma reagin test was negative. A lumbar puncture was performed with normal
cell count and protein. A cerebrospinal fluid Venereal Disease Research Laboratory
test was negative. She was diagnosed with neurosyphilis and treated with intravenous
steroids and penicillin G, with near complete resolution of symptoms.
Why should an Emergency Physician Be Aware of This?
The Centers for Disease Control and prevention has noted a steady rise of the incidence
of syphilis since 2002. Emergency physicians should be familiar with the spectrum
of the clinical manifestations of syphilis, challenges in diagnostics, and appropriate
treatment course.
Keywords
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References
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Article info
Publication history
Published online: March 27, 2018
Accepted:
January 25,
2018
Received in revised form:
October 24,
2017
Received:
July 26,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
