Syphilis Should not be Overlooked in any Individual, Irrespective of their Condition

Abstract

Introduction: Syphilis remains a significant challenge in public health, largely because of its diverse clinical manifestations, often resulting in underdiagnosis especially among patients with neurogenic disability.

Case description: We present a case of neurosyphilis in a 63-year-old patient with a spinal cord injury. Despite syphilis being a well-established sexually transmitted infection, the exacerbation of neurological and dermatological symptoms during physical examination prompted an investigation into alternative causes beyond the patient's pre-existing paraparesis, ultimately resulting in the diagnosis of neurosyphilis.

Conclusion: This case highlights the importance of considering syphilis as a potential diagnosis in individuals regardless of their medical history.

Learning points: The incidence of syphilis cases is on the rise, presenting an ongoing challenge.Faced with atypical neurological symptomatology, it is necessary to know how to investigate and discuss tertiary syphilis.In the event of neurological worsening in a neuro-injured patient, it is necessary to know how to discuss a curable diagnosis.

Keywords: Neurosyphilis; meningoradiculitis; roseoliform exanthema; sexually transmitted infection; tetraparetic.

Figure 1

Physical examination revealed a rash resembling roseola on the trunk and back, along with erythematous-squamous papules on both arms and upper limbs, leaving behind pink scars.

Figure 2

After 72 hours of anti-syphilitic treatment, the patient developed an extension of cutaneous lesions on the trunk and face, consistent with a Herxheimer reaction.