1259 - Tabes Dorsalis in a Patient Presenting With Increased Frequency of Falls and COVID-19

Case Diagnosis: Tabes Dorsalis

Case Description: 77-year-old male with tabes dorsalis, initially unknown, referred for inpatient rehabilitation due to COVID-related pneumonia debility. He had a four-month history of unexplained falls, which worsened alongside COVID-19 symptoms before hospitalization. CT and MRI showed no acute focal deficits. Initially, there was no apparent medical history explaining spinal cord dysfunction. Further inquiry revealed treatment for ocular syphilis discovered during recent vision loss surgery. Physical exam displayed cognitive decline, gait issues, and urinary incontinence. Strength was 4+/5 to 5/5 in the lower extremities but 4/5 in toe flexors, and 5/5 in the upper extremities with slight finger flexor weakness. Light touch was intact, but two-point discrimination was impaired in his legs, and he couldn't distinguish hot/cold on his right lower extremity. Mild dysmetria was noted, with sporadic great toe proprioception. No hyperreflexia or spasticity was observed, though balance and gait issues suggested spinocerebellar/dorsal column dysfunction.

Discussions: Tabes dorsalis is a classical manifestation of neurosyphilis. This condition is relatively rare, characterized by a 25 year average latency period, which adds complexity to its diagnosis and underscores the significance of a comprehensive medical evaluation. This is especially crucial when neurological symptoms lack a clear etiology. Initially, it was suspected that his worsening falls were COVID related, though no explanation was found for his recurrent falls. Limited initial history suggested possible spinal cord dysfunction with the neurological deficits observed proposing a broad differential diagnosis including: tabes dorsalis, subacute combined degeneration of spinal cord, spinal cord compression, vitamin E deficiency, and multiple sclerosis. Patients with neurological symptoms may not link them to STDs, but a health information exchange could expedite tabes dorsalis diagnosis.

Conclusions: Tabes dorsalis' rare occurrence and prolonged latency can make it appear as unexplained spinal cord dysfunction. This highlights the importance of thorough medical assessments and an integrated health information exchange.