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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2024, vol. 30, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2024303.5642
Published online: 15 July 2024
Case report
J of IMAB. 2024 Jul-Sep;30(3):5642-5644
TABES DORSALIS: IS THE DIAGNOSIS A CHALLENGE NOWADAYS?
Maya Danovska
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Department of Neurology, Faculty of Medicine, Medical University – Pleven, Bulgaria.
ABSTRACT:
Purpose: To present a rare case of neurosyphilis, the tertiary form of syphilitic infection, following adequate but belated treatment and manifesting with a variety of clinical signs and further progression to tabetic neurosyphilis. Known as the "great imitator", neurosyphilis is often misdiagnosed and underestimated.
Materials/methods: A 48-year-old male patient was admitted to the Neurology clinic of UMHAT "Dr Georgi Stranski" Pleven, Bulgaria, with progressive neurological deficit including numbness in the lower limbs, imbalance and wide-based gait. The T2W- MRI showed abnormally high longitudinal signals at Th12-L1 level, consistent with transverse myelitis. CSF analysis revealed leucocytic pleocytosis, elevated proteins and normal glucose. The nerve conduction studies confirmed sensory motor polyneuropathy.
Results: After treatment with intravenous aqueous crystalline (IV) penicillin, 2 million intravenously every 4 hours for 20 days, the sensory symptoms reduced. The coordination disturbances persisted, but the gate showed moderate improvement.
Conclusions: The diagnosis of syphilitic myelitis, known as tabes dorsalis, is always complex, not only because of its rarity but because of its unique clinical presentation with multiple clinical symptoms, mimicking other more common neurological disorders. Though confirmation of the diagnosis needs a lot of laboratory and neuroimaging studies, the option of effective specific treatment is worth all the efforts.
Keywords: neurosyphilis, tabes dorsalis, syphilis, sensory ataxia,
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Please cite this article as: Danovska M. Tabes dorsalis: is the diagnosis a challenge nowadays? J of IMAB. 2024 Jul-Sep;30(3):5642-5644. [Crossref - 10.5272/jimab.2024303.5642]
Correspondence to: Assoc. Prof. Maya Danovska, MD, PhD, Department of Neurology and Neurosurgery, Neurology Clinic, Medical University - Pleven; 1, St. Kliment Ohridski Str, 5800 Pleven, Bulgaria; E-mail: mdanovska@yahoo.com
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Received: 05 March 2024
Published online: 15 July 2024