Clinical Images  |   October 2017
Syphilitic Meningomyelitis
Author Notes
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Gilbert Siu, DO, PhD, Director of Brain Injury and Stroke Rehabilitation, HealthSound Hospital of Vineland, 1237 W Sherman Ave, Vineland, NJ 08360-6920. E-mail: gilbert.siu@gmail.com
     
Article Information
Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   October 2017
Syphilitic Meningomyelitis
The Journal of the American Osteopathic Association, October 2017, Vol. 117, 671. doi:10.7556/jaoa.2017.130
The Journal of the American Osteopathic Association, October 2017, Vol. 117, 671. doi:10.7556/jaoa.2017.130
A 41-year-old man with a 10-year history of HIV was admitted to the hospital after he was found unconscious in his home. His current medication included antiretroviral therapy. Upon awakening, the patient was weak and reported numbness in his upper and lower limbs. Manual muscle testing demonstrated upper and lower limb weakness with decreased sensation to light touch and pinprick below the C5 level. A magnetic resonance image of the spine demonstrated spinal cord edema at C3 through T1 levels, with focal spinal cord enhancement at C6, without spinal cord atrophy (image A and image B, arrows). Rapid plasma reagin, Treponema pallidum hemagglutination assay, and cerebrospinal fluid (CSF) VDRL test results were positive, and syphilitic meningomyelitis was diagnosed. Penicillin G was administered intravenously (24 million U/d for 14 days). Symptoms began to improve after 1 week, and the patient was discharged. 
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