Autoimmune glial fibrillary acidic protein astrocytosis mimicking neurosyphilis—a case report

Abstract Glial fibrillary acidic protein (GFAP) astrocytoma is an autoimmune neuroinflammatory condition. The clinical manifestation of this condition may bear resemblance to that of infectious meningitis. The following report details the case of a female patient who exhibited symptoms of headache and fever, and had a medical history of syphilis. During the patient's hospitalization, the presence of cerebrospinal fluid (CSF) lymphocytosis and elevated total protein levels, the result of the treponema pallidum antibody agglutination test yielded a positive outcome, initially yielded a negative result for GFAP antibodies, neurosyphilis was initially suspected. However, following treatment, the patient's symptoms worsened and she developed urinary dysfunction. The complete enhancement of the spinal magnetic resonance imaging (MRI) revealed a linear strengthening of the spinal membrane at the thoracic spine 9-lumbar 1 region, and a examination for autoimmune encephalitis-associated antibodies yielded positive results for GFAP antibodies. Therefore, autoimmune GFAP astrocytosis should be considered when the patient has a previous history of syphilis and the clinical symptoms and cytological and biochemical tests in the CSF are similar to neurosyphilis, but other tests related to neurosyphilis are negative and there are non-specific changes on imaging.