Neurosyphilis-related myelitis

Syphilis is a multisystem infectious disorder with a myriad of neurological complications, although myelitis is rare. A 29-year-old man presented with sudden onset bilateral leg weakness, back pain and urinary retention. He had a flaccid, areflexic paraplegia with a T10 sensory level but preserved joint position and vibration sense. MR scan of the spine showed a longitudinally extensive myelitis with characteristic 'candle guttering' appearance and 'flip-flop' sign. Syphilis serology was positive in the serum and cerebrospinal fluid. There was a dramatic response to corticosteroids and antimicrobial treatment, which was sustained at follow-up. We encourage the consideration of neurosyphilis in the setting of hyperacute cord syndromes.