{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:43:45Z","timestamp":1771922625614,"version":"3.50.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"\n Background<\/jats:title>\n Neurosyphilis is a disease of the central nervous system (CNS) caused by Treponema pallidum (syphilis spirochete), which usually presents with a variety of nonspecific symptoms and is easily misdiagnosed. Although Treponema pallidum can remain latent after treatment, reactivation may occur in the presence of a compromised or immunosuppressed immune system. This article reports a case of reactivation of neurosyphilis after spinal surgery, with the aim of exploring the possible role of immunosuppression in the process.<\/jats:p>\n <\/jats:sec>\n \n Case presentation<\/jats:title>\n The patient was a 75-year-old female admitted to the hospital with persistent bilateral lower extremity pain and weakness and a past history of syphilis that was cured 31 years ago. Upon admission, the patient was diagnosed with an intradural occupying lesion and underwent T9-T10 intradural space-occupying lesion resection. Postoperatively, the patient developed symptoms of neurogenic bladder and paraplegia, and further examination revealed abnormal cerebrospinal fluid suggestive of reactivation of neurosyphilis. Through syphilis antibody testing and cerebrospinal fluid analysis, the diagnosis of neurosyphilis was finally confirmed and antisyphilis treatment was started.<\/jats:p>\n <\/jats:sec>\n \n Treatment and outcome<\/jats:title>\n The patient received a 14-day course of intravenous benzylpenicillin, which resulted in significant symptomatic improvement and restoration of most functions at discharge. After 12 months of follow-up, the patient had fully recovered, with a progressive decrease in syphilis antibody titers and no neurosyphilis reactivation.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This case emphasizes the importance of preoperative syphilis antibody screening, especially in elderly patients with a history of syphilis. The immunosuppressed state may contribute to the reactivation of syphilis spirochetes; therefore, it is important to consider this potential risk and take appropriate precautions when performing surgical treatments such as spinal surgery. Penicillin remains the therapeutic agent of choice for neurosyphilis, and early diagnosis and treatment are critical to the patient\u2019s prognosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1729673","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T06:37:20Z","timestamp":1768891040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Progressive exacerbation of neurological symptoms in a patient with neurosyphilis following T9-T10 intradural space-occupying lesion resection: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Yongpeng","family":"Meng","sequence":"first","affiliation":[{"name":"The Neurological Disease Center,The Second Hospital of Gansu Province","place":["Lanzhou, Gansu, China"]},{"name":"The Neurological Disease Center,Affiliated Hospital of Northwest Minzu University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Bo","sequence":"additional","affiliation":[{"name":"The Department of Medicine, Northwest Minzu University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongtao","family":"Wei","sequence":"additional","affiliation":[{"name":"The Neurological Disease Center,The Second Hospital of Gansu Province","place":["Lanzhou, Gansu, China"]},{"name":"The Neurological Disease Center,Affiliated Hospital of Northwest Minzu University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3201\/eid3107.250646","article-title":"Syphilitic aortitis with concomitant neurosyphilis in asymptomatic patient","volume":"31","author":"Czulada","year":"2025","journal-title":"Emerging Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.894841","article-title":"Neurosyphilis in China: A systematic review of cases from 2009-2021","volume":"9","author":"Du","year":"2022","journal-title":"Front Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1566578","article-title":"Case Report: Recovery of consciousness ahead of MRI image lesion information in cerebral fat embolism syndrome","volume":"12","author":"Zhuang","year":"2025","journal-title":"Front Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.04.026","article-title":"CARE guidelines for case reports: explanation and elaboration document","volume":"89","author":"Riley","year":"2017","journal-title":"J Clin Epidemiol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1610244","article-title":"AI-driven early detection of severe influenza in Jiangsu, China: A deep learning model validated through the design of multi-center clinical trials and prospective real-world deployment","volume":"13","author":"Chen","year":"2025","journal-title":"Front Public Health"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16946","article-title":"2020 European guideline on the management of syphilis","volume":"35","author":"Janier","year":"2021","journal-title":"J Eur Acad Dermatol Venereology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1571631","article-title":"Risk factors associated with acute pancreatitis in diabetic ketoacidosis patients: a 11-year experience in a single tertiary medical center and comprehensive literature review","volume":"12","author":"Chen","year":"2025","journal-title":"Front Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.02.004","article-title":"Is cognitive behavioral therapy an efficacious treatment for psychological interventions in body dysmorphic disorders? 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