A late manifestation of connatal syphilis

An 8-year old girl from Kazakhstan after unremarkable pregnancy and perinatal period, presented at our hospital with progressive loss of mental functions and gait ataxia since the age of six. Neurologic examination revealed spastic tetraplegia with preference of the lower limbs, mild ataxia, dysarthria and bilateral large and unresponsive pupils. The cerebral MRT showed marked bilateral demyelinisation of the subcortical white matter and mild cortical and subcortical atrophy. SEP to median nerve stimulation showed prolonged central conduction time and high-amplitude N 20-peaks. Peripheral nerve conduction velocities were normal, as were VEP and FAEP. EEG and ophthalmological examination (except pupillary rigidity) showed no abnormal findings. A neurodegenerative storage disease was not confirmed. The cerebrospinal fluid abnormalities: elevated protein content, intrathecal synthesis of immunglobulin and lymhocytic pleocytosis indicated the prevalence of central nervous system infection. Serum (patient and mother) and CSF positive antibodies confirmed the diagnosis of neurologic manifestation of connatal syphilis. The result of antibiotic therapy with penicillin G remains to be seen. Screening for connatal syphilis should be part of diagnostic efforts in patients presenting with deterioration of cognitive and motor functions, regardless of age.