A Case of Acute Transverse Myelitis Associated with Neurosyphilis

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.