Neurosyphilis presenting with Guillain-Barre Syndrome: A Case Report

Background: Syphilis is associated with a wide variety of different systemic presentations, earning it the moniker “The great mimicker”. Neurosyphilis is classically associated with meningovasculitis in the acute-subacute stage and tabes dorsalis and dementia paralytica in later stages. However, one of the less well described presentations includes Guillain-Barre Syndrome. This case presents a patient with neurosyphilis who developed with an ascending polyneuropathy with electrodiagnostic testing consistent with demyelination, supporting a diagnosis of neurosyphilis associated Guillain-Barre Syndrome. Case presentation A 37-year-old female presented to the emergency department with a weakness and difficulty swallowing. She described a three-month history of symptoms, initially starting with a persistent headache followed by one month of a pruritic rash on her chest, palms, and soles. Two weeks ago, she developed weakness in her arms, numbness in her arms and chest, and for the last two days, difficulty swallowing. Neurological exam was notable for multiple cranial neuropathies, distal greater than proximal upper and lower extremity weakness, length-dependent sensory loss, and hyporeflexia. Investigation revealed a positive Venereal Disease Research Laboratory in her cerebrospinal fluid without pleocytosis, contrast enhancement in cranial nerve V, VII, and VIII on MRI, and a demyelinating polyneuropathy on electrodiagnostic testing. She was diagnosed with Guillain-Barre syndrome, secondary to neurosyphilis. The patient acutely declined and required intubation, and ultimately made a full recovery after treatment with plasmapheresis and penicillin. Conclusions: This case describes a clinical entity of syphilitic Guillain-Barre Syndrome and highlights the importance of including syphilis in the differential of a patient presenting with ascending polyradiculopathy, especially given the resurgence of syphilis.