Table.
Clinical Characteristics in Syphilitic Meningomyelitis and Comparison with HIV Myelitis.
| Case 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | This | Syphilitic meningomyelitis | HIV myelitis | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ref 3 | 4 | 5 | 6 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | case | n=13 | n=4 | |
| Age | 46 | 63 | 63 | 35 | 30 | 36 | 38 | 46 | 32 | 28 | 31 | 57 | 49 | 42.6±6.7 (28-63) | 33.5±5.0 (29-40) |
| Sex | M | M | M | M | F | M | M | M | M | M | M | F | M | M: 11, F: 2 | M: 4, F: 0 |
| Symptoms duration (d) | 7 | 12 | 60 | 14 | 30 | 120 | 120 | 14 | 120 | 180 | 10 | 3 | 150 | 64.6±34.7 (3-180) | 23.6±13.5 (7-35) |
| Serum HIV antibody (+) | - | - | - | - | - | - | - | NA | - | - | NA | - | + | 1 | 4 |
| MSM | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | + | 1 | 4 |
| Frequent period | <6 years after syphilitic infection | Early phase of HIV infection | |||||||||||||
| Neurological symptoms | |||||||||||||||
| Superficial sensory deficit | + | - | + | NA | NA | + | + | + | + | + | + | + | + | 10/11, 91% | 3/4 |
| Hyperreflexia | + | - | - | NA | NA | + | + | + | + | + | + | + | + | 9/11, 82% | 2/4 |
| Weakness in extremities | - | + | + | NA | NA | + | + | - | + | + | + | + | - | 8/11, 73% | 3/4 |
| Impaired deep sense | - | - | - | NA | NA | + | + | + | - | + | - | + | + | 6/11, 55% | 0/4 |
| Urinary disturbance | - | - | + | NA | NA | - | + | + | + | - | + | - | + | 6/11, 55% | 3/4 |
| Pain | + | + | - | NA | NA | + | + | - | - | - | - | - | - | 4/11, 36% | 3/4 |
| Areflexia | - | - | - | NA | NA | - | - | - | - | - | - | - | - | 0/11 | 1/4 |
| Physical symptoms | |||||||||||||||
| Rash | - | - | + | NA | NA | - | - | - | - | + | - | - | - | 2/11, 18% | 2/4 |
| Fever | - | - | + | NA | NA | - | - | - | - | - | - | - | - | 1/11, 9% | 3/4 |
| Fatigue | - | - | - | NA | NA | - | - | - | - | - | - | - | - | 0/11 | 2/4 |
| Dry cough | - | - | - | NA | NA | - | - | - | - | - | - | - | - | 0/11 | 2/4 |
| Sore throat | - | - | - | NA | NA | - | - | - | - | - | - | - | - | 0/11 | 2/4 |
| Pharyngeal candidiasis | - | - | - | NA | NA | - | - | - | - | - | - | - | - | 0/11 | 2/4 |
| CSF analysis | |||||||||||||||
| Cell count (/μL) | 113 | 303 | 498 | 115 | 170 | 346 | 18 | ↑ | 40 | 196 | 120 | ↑ | 202 | 192.8±83.8 (18-498) | 108.8±114.6 (8-302) |
| % lymphocytes (%) | 100 | 84 | 63 | 85 | 90 | 99 | 72 | NA | 100 | 97 | 100 | NA | 95 | ||
| Protein (mg/dL) | 72 | 92 | 200 | 123 | 57 | 243 | 88 | ↑ | 40 | 109 | 94 | Normal | 79 | 108.8±36.0 (40-243) | 128.5±141.5 (29-343) |
| Immunological reaction for syphilis | iTPA index↑ | RPR+ | VDRL+ | VDRL+ | VDRL+ | FTA+ TPHA+ | VDRL+ | + | VDRL+ | VDRL+ FTA+ | TPHA+ VDRL+ | VDRL+ | TPHA index↑ | iTPA or TPHA index↑ RPR+, VDRL+, FTA+ | NA |
| Laboratory test | Blood HIV-RNA copy↑(12,900-2,400,000 cp/mL) | ||||||||||||||
| MRI findings (locations) | T6-Con | T6-T11 | WS | T4-Con | WS | C-T | T6-T7 | T | T5-T12 | T6-T8 | NA | WS | C4-T6 | ||
| LETM | + | + | + | + | + | + | - | + | + | + | - | + | + | 11/13, 85% | 1/4 |
| Gadolinium-enhancement | + | + | + | NA | NA | + | + | + | NA | NA | + | + | + | 9/13, 69% | 1/4 |
| No abnormal lesion | - | - | - | - | - | - | - | - | - | - | - | - | - | 0/13 | 1/4 |
| Treatment | |||||||||||||||
| Antiluetic therapy | PCG | CTRX | PCG | PCG | PCG | PCG | PCG | AB | PCG | PCG | PCG | PCG | PCG | 13/13, 100% | NA |
| Steroids | mPSL | mPSL | DEX | mPSL | - | - | PSL | - | - | DEX | PSL | DEX | mPSL | 9/13, 69% | 2/4 |
| HAART | - | - | - | - | - | - | - | - | - | - | - | - | - | 0/13 | 2/4 |
| Human immunoglobulin | - | - | - | - | - | - | - | - | - | - | - | - | - | 0/13 | 1/4 |
| Observation | - | - | - | - | - | - | - | - | - | - | - | - | - | 0/13 | 1/4 |
Ref: reference, M: male, F: female, NA: not applicable, MSM: men who have sex with men, iTPA: intrathecal Treponemapallidum antibody, VDRL: venereal disease research laboratory, FTA: fluorescent treponemal antibody, TPHA: treponema pallidum hemagglutination assay, T: thoracic, WS: whole spinal cord, Con: conus, C: cervical, LETM: longitudinally extensive transverse myelitis, PCG: penicillin G, AB: antibiotics, CTRX: ceftriaxone, mPSL: methyl-prednisolone, DEX: dexamethasone, PSL: prednisolone, HAART: highly activated anti-retroviral therapy