Gummatous neurosyphilis in an elderly patient in the Australian outback: a case report

Introduction Neurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges. Despite being an Old World disease, the rates of infection continue to rise. This clinical challenge involves early and accurate diagnosis, as neurosyphilis masquerades with various clinical symptoms and is often missed during initial presentation to the hospital. A comprehensive history and clinical examination are essential to detect suspicious cases early for further cerebrospinal fluid examination and neuroimaging. Patients treated with benzylpenicillin for a specific duration often show promising clinical and cognitive improvement, thus emphasizing the need for constant vigilance in our day-to-day practice. Case presentation A 77-year-old Caucasian gentleman presented to our hospital repeatedly with multiple episodes of presyncope and cognitive impairment. He also demonstrated bilateral deafness, tabes dorsalis, and left sixth cranial nerve palsy. His cerebrospinal fluid examination showed a nonreactive venereal disease research laboratory test, and magnetic resonance imaging of the brain revealed a gumma. Conclusion The diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging.

T. Prout and A. Taylor. Severing the posterior roots in the case of persistent gastralgia in a tabetic. Introspinal neurectomy for intractable tabetic gastralgia. — Journ. of Nervous and Ment. Diseases, 1910, № 7

Patient 50 years old, 7 years old suffers from tabes dorsalis. One of the early symptoms of this disease was severe pain in the stomach, against which the patient was forced to resort, for more than 5 years, to injections of morphine.

N. Willige. Observations on the action of Ehrlich-Hata on neurological and psychiatric material. Uber Erfahrung mit Ehrlich-Hata 606 an psychiatrisch-neurologischen Material.—Münch. med. Wochensch. 1910, № 46

Injections of the drug "606" were made in 35 patients; 5 had repeated injections; 21 of them suffered from progression paralysis, 3 taboparalyse, 5 lues cerebri, 3 tabes dorsalis, 1 lues spinalis, and, finally, in 2 cases the diagnosis could not be established with certainty.

Prof. Treupel. Further observations on injections of Ehrlich Hata, especially in syphilis of the central nervous system, in tabes dorsalis and paralysisѣ.Weitere Erfarungen mit Ehrlich-Hata Injectionen, insbesondere bei Lues des zentralen Nervensystem bei Tabes und Paralyse.—Münch. med. Woch. 1910, №46

The author produced injections of Ehrlich Hata for syphilis of the central nervous system, for tabes dorsalis and paralysis progressiva. The most favorable results were obtained by him in syphilis of the central nervous system.

Tabetic Arthropathy

Tabetic Arthropathy (TA) defines bone- and joint-destructive processes associated with neurosensory deficits due to syphilis infection. It occurs at the late stages of the disease, and affects 10% of patients with Tabes Dorsalis. The mean age at diagnosis is 60 years with a predilection for male patients. TA became less common thanks to the early diagnosis of syphilis infection, but its management remains complicated given the severity of injuries and the lack of specific treatment. TA can affect every joint, mainly the knees. Patients usually present with a single painless and swollen joint. Deformities are seen in advanced stages. Plain radiographs and CT findings include subchondral sclerosis, osteophytosis, subluxation, and soft tissue swelling. MRI shows articular destruction with irregularities of articular surfaces, deformation, and intraarticular effusion. It also helps differentiate neuropathic osteoarthropathy from other articular diseases as infection, osteonecrosis, and psoriatic arthritis (Figure 1 and 2).

John Goodsir (1814–1867) and his neurological illness

John Goodsir, conservator and professor of anatomy at the University of Edinburgh, suffered an unidentified illness described by experts after his death as tabes. The features that led to this diagnosis, the understanding of tabes at that time and its relationship in some cases to syphilis, are discussed. It is concluded that the most likely diagnoses are subacute combined degeneration of the cord as a result of malnutrition or tabes dorsalis resulting from earlier syphilis. The presence of ‘lightning pains’ leans towards the latter diagnosis but evidence for a means of acquisition of syphilis is lacking. The disadvantages of retrospective diagnosis are discussed.