Summary

Background: Syphilis, widely recognized as “the great imitator”, frequently poses diagnostic challenges due to the polymorphism of its clinical manifestations. The intersection between Treponema pallidum infection and immune-mediated pathologies, such as Guillain-Barré Syndrome (GBS), raises fundamental questions regarding the role of infectious triggers in initiating systemic autoimmunity.

Objective: To present a complex case of acutely installed flaccid tetraparesis in a patient with positive syphilitic serology, highlighting the interdisciplinary management.
Material and methods: A retrospective case report study focusing on a 56-year-old male admitted to the emergency department. The evaluation included detailed clinical examinations (neurological and dermatological), para-clinical investigations (CSF analysis, brain and spinal MRI, dynamic biochemistry), and monitoring the response to combined therapeutic interventions.

Results: The patient exhibited predominantly proximal tetraparesis, abolished deep tendon reflexes, and right-sided peripheral facial nerve palsy. CSF analysis revealed albumin-cytologic dissociation. Serological testing con-firmed late latent syphilis, discovered incidentally. Under a combined treatment regimen (intravenous immuno-glo-bulins, corticosteroids, and an antibiotic protocol consisting of Tetracycline followed by Benzathine Penicillin), the clinical course was favorable, resulting in a partial remission of the motor deficit.

Conclusions: This case underscores the necessity of systematic syphilitic serological screening in all acute neurological presentations of the polyradiculoneuritis type. Eradicating the infectious focus is essential to prevent neuroprogression and ensure the success of the neurological rehabilitation program.