Disclosures: Tova E. Plaut, DO: No financial relationships or conflicts of interest

Case Description: 70- year-old female referred to PM&R clinic for presumed osteoarthritis causing a progressively worsening gait. Physical exam revealed profound ataxia, Trendelenburg gait, absent deep tendon reflexes in bilateral lower extremities and slow, premeditated movements. NCS/EMG study and MRI of brain and entire spine did not reveal pathology. Routine bloodwork was within normal limits, however serum Treponema Pallidum, reflexive rapid plasma regain (RPR), and fluorescent treponema antibody absorption (FTA-ABS) were all reactive. A lumbar puncture was performed and all cerebrospinal fluid studies were non-reactive. Of note, this patient denied a history of sexually-transmitted illness in her life-time, including Syphilis. A diagnosis of latent Neurosyphilis was made and the patient was subsequently treated with intramuscular penicillin G.

Setting: PM&R Outpatient musculoskeletal clinic at a community teaching hospital

Patient: 70-year-old female with no past medical history referred by primary care to rehab clinic for worsening gait disturbance due to presumed osteoarthritis. Assessment/

Results: On four week follow up, after completion of treatment with penicillin, the patient reported significant improvement in her balance and gait.

Discussion: While this patient was diagnosed with osteoarthritis as the cause of her difficulty with ambulation, by creating a broader differential and performing a more comprehensive work-up, an atypical case of neurosyphilis was appropriately diagnosed and treated. Neurosyphilis (NS) is a tertiary form of syphilis and is caused by the spirochete Treponema pallidum. While there are several “classic” forms of NS such as symptomatic meningitis, meningovascular syphilis, general paresis, and tabes dorsalis, patients may present atypically. The above patient had reactive serum studies, negative CSF studies, and negative imaging. Regardless of presentation and findings, treatment with typical Penicillin resulted in a significant improvement in symptoms.

Conclusion: In a geriatric patient with a progressive gait disturbance, one must keep Neurosyphilis on the differential as it is a known cause of ataxia and weakness that can be treated.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/geriatric-gait-dysfunction-caused-by-neurosyphilis/