Tabes dorsalis: a rare presentation of neurosyphilis in Western Europe

We present a case of tabes dorsalis with delayed diagnosis in a carpenter who presented with a VIth cranial nerve palsy, decreased deep tendon reflexes, reduced sense of vibration and an unsteady gait. After deterioration of symptoms with almost complete loss of vision due to bilateral optic atrophy, pronounced relative afferent pupillary defect and severe gait ataxia, and 4 years of extensive diagnostic testing and ineffective treatments, including several MRIs, genetic analysis and eye surgeries, serological testing was positive for syphilis. Elevated <i>Treponema pallidum</i> activity markers in the serum and cerebrospinal fluid confirmed the diagnosis. The patient then disclosed a history of syphilis 30 years ago, treated insufficiently with an oral antibiotic. While laboratory results improved, no clinical amelioration was achieved after treatment. This case demonstrates the need for thorough medical history and targeted diagnostic workup to achieve early recognition, diagnosis and treatment of neurosyphilis to prevent irreversible sequelae.