Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2019; 7(11): 1282-1290
Published online Jun 6, 2019. doi: 10.12998/wjcc.v7.i11.1282
Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging
Jun-Liang Yuan, Wei-Xue Wang, Wen-Li Hu
Jun-Liang Yuan, Wen-Li Hu, Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Wei-Xue Wang, Department of Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: Yuan JL and Wang WX are co-first authors; Yuan JL, Wang WX, and Hu WL designed and performed the research; Yuan JL and Wang WX collected and analyzed the data; Yuan JL and Wang WX wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81301016; and the Beijing Municipal Administration of Hospitals Incubating Program, No. PX2019009.
Institutional review board statement: Our work was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University.
Informed consent statement: The patient gave informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen-Li Hu, MD, Director, Doctor, Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti South, Chaoyang District, Beijing 100020, China. wenlihu3366@126.com
Telephone: +86-10-85231376 Fax: +86-10-85231376
Received: January 23, 2019
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

Our study was aimed to summarize the clinical features of syphilitic myelitis with longitudinally extensive myelopathy.

Research methods

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.

Research results

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.

Research conclusions

Our case raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries.

Research perspectives

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.