Loading
Autoimmune and Inflammatory Disorders · Journal article
BMC Neurology · August 18, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of a 31-year-old man with longitudinally extensive transverse myelitis (T6–T10) in whom neurosyphilis was diagnosed on the basis of reactive serum and cerebrospinal fluid syphilis serology, negative autoimmune antibody testing, and clinical response to ceftriaxone and corticosteroids. The diagnosis is classified as probable rather than definitive because the initial cerebrospinal fluid sample was blood-contaminated and lacked pleocytosis, limiting diagnostic certainty.
Case report. 31-year-old male with one-month history of progressive bilateral lower-limb thermal dysesthesia, hyperesthesia, proximal leg weakness, pyramidal signs, urinary retention, and fecal incontinence; HIV-negative.. Intervention: Ceftriaxone-based anti-treponemal therapy with adjunctive corticosteroids. n = 1.
31-year-old male with one-month progressive bilateral lower-limb dysesthesia, leg weakness, pyramidal signs, urinary retention, and fecal incontinence Spinal MRI showed longitudinally extensive central thoracic cord T2 hyperintensity from T6 to T10 Serum syphilis serology and CSF Venereal Disease Research Laboratory testing were reactive; aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies were negative
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This case reinforces that neurosyphilis should be considered in the differential diagnosis of longitudinally extensive transverse myelitis, particularly when prominent sphincter dysfunction is present and autoimmune serologies are negative. Clinicians should test for syphilis early in LETM workup, but recognition that atypical CSF findings and contamination may limit diagnostic certainty is important.
Single case report with probable (not definitive) diagnosis due to technical limitations in CSF testing; illustrates a clinical presentation and treatment response but cannot establish efficacy or causation.
As stated by the source record.
Quoted from the source exactly as published.
This case reinforces that neurosyphilis should be considered in the differential diagnosis of longitudinally extensive transverse myelitis, particularly when prominent sphincter dysfunction is present and autoimmune serologies are negative. Clinicians should test for syphilis early in LETM workup, but recognition that atypical CSF findings and contamination may limit diagnostic certainty is important.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background Longitudinally extensive transverse myelitis (LETM) is often investigated as an autoimmune inflammatory myelopathy, but treatable infectious mimics should also be considered. Neurosyphilis-associated myelitis is uncommon and may resemble aquaporin-4 or myelin oligodendrocyte glycoprotein antibody-associated disease. Case presentation A 31-year-old man presented with a one-month history of progressive bilateral lower-limb thermal dysesthesia and hyperesthesia, proximal leg weakness, pyramidal signs, urinary retention, and fecal incontinence. Spinal magnetic resonance imaging showed a longitudinally extensive central thoracic cord T2 hyperintensity from T6 to T10. Serum syphilis serology and cerebrospinal fluid Venereal Disease Research Laboratory testing were reactive, whereas human immunodeficiency virus testing was negative, serum aquaporin-4 and serum myelin oligodendrocyte glycoprotein antibodies were negative, and oligoclonal bands were absent. Because the initial cerebrospinal fluid sample was blood-contaminated and showed no pleocytosis, the diagnosis was considered probable neurosyphilis-associated LETM rather than definitive syphilitic myelitis. The patient received ceftriaxone-based anti-treponemal therapy with adjunctive corticosteroids. Follow-up cerebrospinal fluid Venereal Disease Research Laboratory testing became non-reactive, spontaneous voiding recovered, and follow-up spinal magnetic resonance imaging showed radiologic resolution. Conclusions Probable neurosyphilis-associated LETM can mimic seronegative inflammatory myelitis. Syphilis testing should be considered early in LETM, particularly when prominent sphincter dysfunction is present. Diagnostic certainty may be limited by atypical cerebrospinal fluid findings, blood contamination, and concomitant antimicrobial and corticosteroid treatment.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.