ArticleFrontiers in immunology2026
Case Report: Neurosyphilis with a paraparetic Guillain-Barré-spectrum phenotype and CSF-detected anti-GT1a IgG: an infection-autoimmunity diagnostic challenge.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Active central nervous system (CNS) infection can resemble acute immune polyradiculoneuropathy, and the two processes may coexist. We describe a patient with neurosyphilis, rapidly progressive paraparetic weakness, and anti-GT1a IgG detected in cerebrospinal fluid (CSF) but not serum by a qualitative line immunoblot. Case presentation: A 41-year-old man developed rapidly progressive paraparesis, urinary retention, and left abducens palsy. On hospital day 2, CSF opening pressure was 260 mmH Conclusion: Neurosyphilis can present with a paraparetic GBS-spectrum phenotype, making it difficult to determine whether syphilitic meningoradiculitis alone explains the syndrome or whether a concurrent immune polyradiculoneuropathy is also present. In this setting, blood-CSF barrier dysfunction, CSF-detected anti-GT1a IgG, and improvement after IVIG should be viewed as hypothesis-generating observations rather than proof of antibody compartmentalization, dual pathology, or treatment causality. In similar cases, longitudinal clinical follow-up, electrophysiology, imaging, and quantitatively validated paired serum-CSF immune testing are needed to distinguish a single infectious process, a concurrent immune neuropathy, and a biologically linked infection-autoimmunity process.
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