title: Lupus or syphilis? That is the question!
abstract: 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 month 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 Treponema pallidum haemagluttin antigen (TPHA) of 1/640, positive anti-nuclear antibodies of 1/640 and nephrotic proteinuria (3.6 g/24 h). 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.
authors.affiliation: Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal.
authors.forename: Joana Azevedo
authors.initials: JA
authors.lastname: Duarte
authors.affiliation: Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal Department of Internal Medicine 2, Curry Cabral Hospital, Lisbon, Portugal.
authors.forename: Celia Coelho
authors.initials: CC
authors.lastname: Henriques
authors.affiliation: Department of Pneumology, Fernando Fonseca Hospital, Amadora, Portugal.
authors.forename: Carolina
authors.initials: C
authors.lastname: Sousa
authors.affiliation: Department of Internal Medicina IV, Fernando Fonseca Hospital, Amadora, Portugal.
authors.forename: José Delgado
authors.initials: JD
authors.lastname: Alves
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology*; D009494:Neurosyphilis / Q000175:diagnosis; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D013116:Spinal Cord / Q000473:pathology; D013129:Spinal Puncture; D013587:Syphilis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D013588:Syphilis Serodiagnosis; D014210:Treponema pallidum
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; D003520:Cyclophosphamide; D010401:Penicillin G Benzathine