Thursday, October 15, 2015

Tabes dorsalis in the post antibiotic era: never say never

We present the case of an HIV positive 47 year old male with a CD4 count of 400 and an undetectable viral load on HAART. He presented with an 8 month history of progressively severe lightening pains, gait disturbance, tinnitus, hearing loss, and urinary incontinence. He had a positive plasma VDRL with a titre of 1:32, and his CSF was VDRL positive. Whole spine MRI scan demonstrated high signal in the dorsal cord with associated atrophy. He was treated with intravenous benzylpenicillin 2.4 grams 4 hourly for 14 days. Follow up at 4 and 8 months demonstrated marked clinical improvement with a falling serum VRDL titre. Repeat LP at 6 month post treatment demonstrated VDRL negativity. Discussion Tabes Dorsalis may still occur in the post antibiotic era. Early recognition and appropriate …

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