Neurosyphillis is a great imitator because of its various clinical symptoms. Neurosyphillis can affect spinal cord with meningomyelitis, meningovascular disease or tabes dorsalis. Rarely it can present as Neuromyelitis optica spectrum disorder Long segment Extensive Transverse Myelitis (LETM).This report describes a case of tabes dorsalis in a 25 year old homosexual man who presented with ataxia and was ultimately found to have positive VDRL and TPHA in serum and CSF .CSF showed higher values of cells and protein. Exclusion of syphilis is important prior to considering neuromyeltis optica in LETM cases.
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