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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 <jats:italic>Treponema pallidum<\/jats:italic> 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.<\/jats:p>","DOI":"10.1136\/bcr-2024-262492","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T09:35:27Z","timestamp":1738575327000},"page":"e262492","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Tabes dorsalis: a rare presentation of neurosyphilis in Western Europe"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1815-623X","authenticated-orcid":false,"given":"Nando","family":"Bloch","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St. Gallen, St.Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Brugger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4821-9995","authenticated-orcid":false,"given":"Julia","family":"Notter","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Infection Prevention and Travel Medicine, Cantonal Hospital St. Gallen, St.Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"2025082702324825000_18.2.e262492.1","unstructured":"Sexually transmitted infections surveillance. 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S\u00cdFILIS: formas de presentaci\u00f3n poco frecuentes."},{"key":"2025082702324825000_18.2.e262492.11","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMicm1507564","article-title":"Tabes Dorsalis and Argyll Robertson Pupils","volume":"375","author":"Osman","year":"2016","journal-title":"N Engl J Med"},{"key":"2025082702324825000_18.2.e262492.12","doi-asserted-by":"crossref","DOI":"10.1038\/s41394-019-0185-9","article-title":"Medullary involvement in neurosyphilis: a report of 12 cases and a review of the literature","volume":"5","author":"Elmouden","year":"2019","journal-title":"Spinal Cord Ser Cases"},{"key":"2025082702324825000_18.2.e262492.13","article-title":"Traditional Neurosyphilis in 21st Century - Tabes Dorsalis, Dementia Paralytica, Aseptic Meningitis and Unilateral Oculomotor Nerve Palsy in an HIV-Negative Man","volume":"13","author":"Landeiro","year":"2021","journal-title":"Cureus"},{"key":"2025082702324825000_18.2.e262492.14","article-title":"Tabes Dorsalis in a Patient Presenting With Right Lower Extremity Paresthesia and Cervical Spine Pain","volume":"13","author":"Creech","year":"2021","journal-title":"Cureus"},{"key":"2025082702324825000_18.2.e262492.15","doi-asserted-by":"crossref","unstructured":"Reyes AJ , Ramcharan K , Aboh S , et al . Dilated tonic pupils with tabes dorsalis in neurosyphilis as first manifestation of HIV\/AIDS: a video report. BMJ Case Rep 2018. doi:10.1136\/bcr-2017-223727","DOI":"10.1136\/bcr-2017-223727"},{"key":"2025082702324825000_18.2.e262492.16","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1711-z"},{"key":"2025082702324825000_18.2.e262492.17","unstructured":"Bhandari J , Thada PK , Leslie SW , et al . Tabes dorsalis. In: StatPearls. StatPearls Publishing, 2024. 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