{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:09:10Z","timestamp":1768568950374,"version":"3.49.0"},"reference-count":29,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,5,8]]},"abstract":"<jats:p>A 47-year-old man presented with fever, a maculopapular rash of the palms and soles, muscular weakness, weight loss, faecal incontinence, urinary retention and mental confusion with 1\u2005month of evolution. Neurological examination revealed paraparesis and tactile hypoesthesia with distal predominance, and no sensory level. Laboratory investigations revealed a venereal disease research laboratory (VDRL) titre of 1\/4 and <jats:italic>Treponema pallidum<\/jats:italic> haemagluttin antigen (TPHA) of 1\/640, positive anti-nuclear antibodies of 1\/640 and nephrotic proteinuria (3.6\u2005g\/24\u2005h). Lumbar puncture excluded neurosyphilis, due to the absence of TPHA and VDRL. The diagnosis of systemic lupus erythematosus (SLE) was established and even though transverse myelitis as a rare presentation of SLE has a poor outcome, the patient improved with cyclophosphamide, high-dose corticosteroids and hydroxychloroquine. A diagnosis of secondary syphilis was also established and the patient was treated with intramuscular benzathine penicillin G.<\/jats:p>","DOI":"10.1136\/bcr-2015-209824","type":"journal-article","created":{"date-parts":[[2015,6,4]],"date-time":"2015-06-04T11:59:34Z","timestamp":1433419174000},"page":"bcr2015209824","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Lupus or syphilis? That is the question!"],"prefix":"10.1136","volume":"2015","author":[{"given":"Joana Azevedo","family":"Duarte","sequence":"first","affiliation":[{"name":"Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal"}]},{"given":"Celia Coelho","family":"Henriques","sequence":"additional","affiliation":[{"name":"Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal"},{"name":"Department of Internal Medicine 2, Curry Cabral Hospital, Lisbon, Portugal"}]},{"given":"Carolina","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Fernando Fonseca Hospital, Amadora, Portugal"}]},{"given":"Jos\u00e9 Delgado","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2015,6,4]]},"reference":[{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780261218"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.2","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-1-6"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.3","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181e8138e"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.4","doi-asserted-by":"publisher","DOI":"10.1191\/0961203303lu2021oa"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keg069"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60279-7"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.7","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-83-5-616"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.59.2.120"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.9","first-page":"280","article-title":"Transverse myelitis as the first manifestation of systemic lupus erythematosus or lupus-like disease: good functional outcome and relevance of anti-phospholipid antibodies","volume":"31","author":"D'Cruz","year":"2004","journal-title":"J Rheumatol"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.10","doi-asserted-by":"publisher","DOI":"10.1007\/BF00314433"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.11","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780270915"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.12","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780300818"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.13","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.060665"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.14","first-page":"35","article-title":"Secondary syphilis: uncommon manifestatons of a common disease","volume":"140","author":"McPhee","year":"1984","journal-title":"West J Med"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.15","first-page":"1","article-title":"Syphilis","volume-title":"Scientific American medicine","volume":"2","author":"Swartz","year":"1979"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.16","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-197708000-00037"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.17","unstructured":"Medscape.com. Syphilis [updated 22 October 2014; cited 25 October 2014]. http:\/\/emedicine.medscape.com\/article\/229461-overview ."},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.18","unstructured":"Longo D , Fauci A , Kasper D , et al . Glomerular Diseases. In: Lewis JB , Neilson EG, eds . Harrison's principles of internal medicine. 18th edn. McGraw-Hill, 2011:2334\u201354."},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.19","first-page":"89","article-title":"Acute transverse myelitis in systemic lupus erythematosus: magnetic resonance imaging and review of the literature","volume":"17","author":"Boumpas","year":"1990","journal-title":"J Rheumatol"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2011.05.018"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.21","doi-asserted-by":"publisher","DOI":"10.1038\/ki.1994.70"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.22","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006090992"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(98)90150-2"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198603063141004"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2013.07.002"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.26","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000091181.93122.55"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.27","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.101213"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2008.09.002"},{"key":"2025082804130799000_2015.jun04_1.bcr2015209824.29","unstructured":"Vinken PJ , Bruyn GW , Klawans HL . Nervous system involvement in systemic lupus erythematosus including the antiphospholipid antibody syndrome. In: Handbook of clinical neurology. Vol 27 (71): systemic disease part III . Amsterdam: Elsevier Science B.V, 1998:35\u20138."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2015-209824","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:13:14Z","timestamp":1756379594000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2015-209824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,6,4]]},"references-count":29,"alternative-id":["10.1136\/bcr-2015-209824"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2015-209824","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,6,4]]}}}