From the Guidelines
Yes, neurosyphilis can cause transverse myelitis, as it is a manifestation of syphilitic meningomyelitis, a form of transverse myelitis that occurs when Treponema pallidum bacteria infect the central nervous system. This typically develops during tertiary syphilis, years after the initial infection 1. The diagnosis of neurosyphilis is established by examination of the CSF, which might indicate mild mononuclear pleocytosis, normal or mildly elevated protein concentration, or a reactive CSF-VDRL 1.
Key Considerations
- Neurosyphilis can present with a range of symptoms, including weakness, sensory changes, bowel or bladder dysfunction, and back pain.
- Prompt diagnosis is crucial and typically involves CSF analysis showing pleocytosis, elevated protein, and positive treponemal tests.
- The recommended treatment for neurosyphilis is intravenous penicillin G, specifically aqueous crystalline penicillin G 18-24 million units per day, administered as 3-4 million units every 4 hours for 10-14 days 1.
- For penicillin-allergic patients, doxycycline 200 mg twice daily for 28 days may be used, though it's less effective.
- Following treatment, regular clinical and serological monitoring is necessary to ensure resolution of the infection.
Important Notes
- Neurosyphilis should be considered in the differential diagnosis of neurologic disease in HIV-infected persons 1.
- Unusual serologic responses have been observed among HIV-infected persons who have syphilis, and both treponemal and nontreponemal serologic tests for syphilis can be interpreted in the usual manner for most patients who are coinfected with T. pallidum and HIV 1.
From the Research
Neurosyphilis and Transverse Myelitis
- Neurosyphilis can be a cause of transverse myelitis, as evidenced by several case studies 2, 3, 4, 5.
- Transverse myelitis is a rare manifestation of neurosyphilis, and it can be misdiagnosed due to its non-specific symptoms 2, 3.
- The diagnosis of neurosyphilis-induced transverse myelitis can be challenging, but it can be confirmed through serologic tests and cerebrospinal fluid analysis 3, 5.
Clinical Manifestations
- Patients with neurosyphilis-induced transverse myelitis may present with symptoms such as progressive weakness, numbness, and pain in the legs, as well as pelvic dysfunction 3, 4.
- Magnetic resonance imaging (MRI) can show spinal cord lesions, which can be evaluated as spinal syphilis or syphilis-induced myelitis 3, 4.
Treatment
- Treatment of neurosyphilis-induced transverse myelitis typically involves intravenous penicillin and corticosteroids 2, 4, 5.
- Early treatment can improve neurological prognosis, while delayed treatment may result in no improvement or worsening of symptoms 2, 4.
- In some cases, patients may require additional courses of treatment or alternative therapies, such as pulse steroid therapy 4.