{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T18:24:45Z","timestamp":1766082285850,"version":"3.48.0"},"reference-count":17,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100015544","name":"King\u2019s College Hospital Charity","doi-asserted-by":"publisher","award":["D2137\/112024\/Silber\/2940"],"award-info":[{"award-number":["D2137\/112024\/Silber\/2940"]}],"id":[{"id":"10.13039\/100015544","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2025,11,9]]},"abstract":"<jats:p>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 \u2018candle guttering\u2019 appearance and \u2018flip-flop\u2019 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.<\/jats:p>","DOI":"10.1136\/pn-2025-004893","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T18:20:32Z","timestamp":1766082032000},"page":"pn-2025-004893","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Neurosyphilis-related myelitis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-4085","authenticated-orcid":false,"given":"Milo Patrick","family":"Delaney","sequence":"first","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiran Ajith","family":"Paranavitane","sequence":"additional","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larissa","family":"Mulka","sequence":"additional","affiliation":[{"name":"Caldecot Centre, King\u2019s College Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Chandra","sequence":"additional","affiliation":[{"name":"Neuroradiology, King\u2019s College Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Hamlyn","sequence":"additional","affiliation":[{"name":"Caldecot Centre, King\u2019s College Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli","family":"Silber","sequence":"additional","affiliation":[{"name":"Neurology, King\u2019s College Hospital NHS Foundation Trust, London, England, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"2025121810202903000_pn-2025-004893v1.1","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1212\/CON.0000000000000250","article-title":"Neurosyphilis","volume":"21","author":"Marra","year":"2015","journal-title":"Continuum (Minneap Minn)"},{"key":"2025121810202903000_pn-2025-004893v1.2","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1080\/10790268.2019.1658283","article-title":"Syphilitic meningomyelitis misdiagnosed as spinal cord tumor: Case and review","volume":"44","author":"Dong","year":"2021","journal-title":"J Spinal Cord Med"},{"key":"2025121810202903000_pn-2025-004893v1.3","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.12998\/wjcc.v7.i11.1282","article-title":"Clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging","volume":"7","author":"Yuan","year":"2019","journal-title":"WJCC"},{"key":"2025121810202903000_pn-2025-004893v1.4","unstructured":"UK Health Security Agency . Tracking the syphilis epidemic in England: 2013 to 2023. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/tracking-the-syphilis-epidemic-in-england\/tracking-the-syphilis-epidemic-in-england-2013-to-2023 [Accessed 14 Aug 2025]."},{"key":"2025121810202903000_pn-2025-004893v1.5","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1177\/09564624241280406","article-title":"BASHH UK guidelines for the management of syphilis 2024","volume":"35","author":"Kingston","year":"2024","journal-title":"Int J STD AIDS"},{"key":"2025121810202903000_pn-2025-004893v1.6","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16946"},{"key":"2025121810202903000_pn-2025-004893v1.7","unstructured":"Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021 . Neurosyphilis, ocular syphilis, and otosyphilis. 2021. Available: https:\/\/www.cdc.gov\/std\/treatment-guidelines\/neurosyphilis.htm [Accessed 27 Oct 2025]."},{"key":"2025121810202903000_pn-2025-004893v1.8","unstructured":"Merritt HH , Adams RD , Solomon HC . Neurosyphilis. New York: Oxford University Press, 1946."},{"key":"2025121810202903000_pn-2025-004893v1.9","unstructured":"Berger JR . Neurosyphilis. In: Lewis SL , ed. MedLink neurology. San Diego: MedLink LLC, 2025. Available: https:\/\/www.medlink.com\/articles\/neurosyphilis [accessed 14 Aug 2025]."},{"key":"2025121810202903000_pn-2025-004893v1.10","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1984.04050150119030"},{"key":"2025121810202903000_pn-2025-004893v1.11","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2021-003148"},{"key":"2025121810202903000_pn-2025-004893v1.12","doi-asserted-by":"publisher","DOI":"10.1177\/19418744221075402"},{"key":"2025121810202903000_pn-2025-004893v1.13","doi-asserted-by":"crossref","DOI":"10.1038\/s41394-023-00560-y","article-title":"Chronic flaccid quadriparesis from tract specific myelopathy in neurosyphilis","volume":"9","author":"Miraclin T","year":"2023","journal-title":"Spinal Cord Ser Cases"},{"key":"2025121810202903000_pn-2025-004893v1.14","doi-asserted-by":"crossref","first-page":"587","DOI":"10.4103\/aian.aian_120_23","article-title":"Neurosyphilis Manifesting as Longitudinally Extensive Transverse Myelitis","volume":"26","author":"Agarwal","year":"2023","journal-title":"Ann Indian Acad Neurol"},{"key":"2025121810202903000_pn-2025-004893v1.15","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1177\/19418744241258694","article-title":"Neurosyphilis Manifesting as a Longitudinally Extensive Transverse Myelitis: A Case Report","volume":"14","author":"Bou","year":"2024","journal-title":"Neurohospitalist"},{"key":"2025121810202903000_pn-2025-004893v1.16","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-003-0921-7"},{"key":"2025121810202903000_pn-2025-004893v1.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1906228"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2025-004893","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T18:20:34Z","timestamp":1766082034000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2025-004893"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":17,"alternative-id":["10.1136\/pn-2025-004893"],"URL":"https:\/\/doi.org\/10.1136\/pn-2025-004893","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}