Infect Chemother.  2012 Dec;44(6):446-449. 10.3947/ic.2012.44.6.446.

A Case of Acute Transverse Myelitis Associated with Neurosyphilis

• Lee CB
• Choi SM
• Kim SJ
• Chae BG
• Kim JH
• Jin SS
• Joung MK

• KMID: 1806929
• DOI: http://doi.org/10.3947/ic.2012.44.6.446

Abstract

Syphilitic myelitis is a rare manifestation of neurosyphilis, whose magnetic resonance imaging findings are not well documented. The authors report on a case of a 48-year-old male who presented with acute onset of paraplegia and voiding difficulty and was diagnosed as having syphilitic myelitis. Among tests performed for the diagnosis, serum Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorbed (FTA-ABS) tests showed a positive result. Analysis of cerebrospinal fluid (CSF) showed a normal white blood cell count, increased protein, reactive VDRL, and FTA-ABS tests. Magnetic resonance imaging (MRI) of cervical and thoracic spines showed diffuse intramedullary T2-hyperintense signal intensity without T1-weighted gadolinium enhancement. The syphilitic myelitis was resolved after institution of intravenous high dose penicillin G therapy for two weeks. Additional follow-up CSF analysis performed three months after treatment showed decreased protein and negative VDRL. MRI taken nine months later appeared normal and VDRL in CSF was still negative. This case study reports on the first Korean case of acute transverse myelitis caused by syphilis.

Keyword

Neurosyphilis; Acutetransversemyelitis; Magnetic resonance imaging (MRI)

MeSH Terms

Fluorescent Treponemal Antibody-Absorption Test
Follow-Up Studies
Gadolinium
Humans
Leukocyte Count
Magnetic Resonance Imaging
Male
Myelitis
Myelitis, Transverse
Neurosyphilis
Paraplegia
Penicillin G
Sexually Transmitted Diseases
Spine
Syphilis
Gadolinium
Penicillin G

Figure

• 

  Figure 1 T2 weighted image obtained by T-spine MRI showing intramedullary high signal intensity from the lower C-spine to L1, suggestive of non-tumorous myelopathy. (A) Sagittal image showing long segmental signal change of the spinal cord. (B) Axial image showing the concentric locations of lesions.

• 

  Figure 2 Follow up T2 weighted T-spine MR images showing normal signal intensity of the spinal cord without myelomalacic change or a focal lesion on sagittal (A) or axial images (B). The signal change attributed to myelitis showed improvement.

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