Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1282
Peer-review started: January 23, 2019
First decision: March 14, 2019
Revised: April 16, 2019
Accepted: May 2, 2019
Article in press: May 2, 2019
Published online: June 6, 2019
Processing time: 135 Days and 14.7 Hours
Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported.
Only a few cases of syphilitic myelitis have been documented in the international literature. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis in the literature.
Our study was aimed to summarize the clinical features of syphilitic myelitis with longitudinally extensive myelopathy.
First, we report a patient who suffered from syphilitic myelitis with symptoms of sensory disturbance, with longitudinally extensive myelopathy with "flip-flop sign" on spinal magnetic resonance imaging (MRI). This patient experienced complete clinical and radiologic recovery after treatment. Second, we summarized the clinical features of syphilitic myelitis with longitudinally extensive myelopathy.
A total of 16 articles of 20 cases were identified. Sixteen patients presented with the onset of sensory disturbance (80%), 15 with paraparesis (75%), and 9 with urinary retention (45%). Eleven patients had a high risk behavior (55%). Five patients had concomitant HIV infection (25%). Serological data showed that 15 patients had positive venereal disease research laboratory test (VDRL)/treponema pallidum particle agglutination (TPHA), and 17 patients had positive VDRL/TPHA in cerebrospinal fluid (CSF). Seventeen patients had elevated cells and protein in CSF. On MRI, 16 patients showed abnormal signal intensities involving the thoracic spine, 6 involved the cervical spine, and 3 involved both cervical and thoracic spine. There were 3 patients with the "flip-flop sign". All the patients were treated with penicillin, and 15 patients had a good prognosis.
Our case raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries.
Attention is drawn upon the importance of doing serological tests for syphilis when any atypical neurological situation is presented. A high index of suspicion is necessary so that this potentially treatable disease would not be overlooked.