AN INTRESTING CASE OF RHABDOMYOLYSIS SECONDARY TO CEREBRAL SYPHILITIC GUMMA IN YOUNG ADULT

Rhabdomyolysis, a potentially life-threatening condition characterized by the breakdown of skeletal muscle tissue and release of intracellular contents, commonly occurs in response to trauma, prolonged immobilization, and certain medications(1). However, its occurrence secondary to neurological disorders, such as cerebral syphilitic gumma, is exceedingly rare(3). Cerebral syphilitic gumma, a tertiary manifestation of syphilis, presents as granulomatous lesions in the brain, typically causing neurological symptoms. The co-occurrence of rhabdomyolysis with syphilitic gumma, though unusual, may reflect the multifactorial impact of neuromuscular compromise such as seizures, prolonged immobilization, and metabolic disturbances triggered by central nervous system pathology(8). We report a case of a 24- year-old male who presented with complaints of involuntary movements of bilateral upper and lower limbs, headache, and difficulty in walking. Laboratory findings revealed elevated creatinine kinase levels (1239 mcg/L), myoglobinuria (>3000 ng/mL) and creatinine 4.2mg/dl leading to initial diagnosis of rhabdomyolysis. MRI of the brain showed a welldefined, ring-enhancing lesion in the right frontal lobe. VDRL serology was reactive and treponema antibody positive. Diagnosis was revised to rhabdomyolysis with acute kidney injury secondary to cerebral syphilitic gumma. Patient was stabilised in ED and treated with benzathine penicillin. Patients with tertiary syphilis poses risk for neurological complications like, focal neurological deficits and convulsions rhabdomyolysis. The incidence of tertiary syphilis has declined in developed countries, but untreated cases still pose a risk for such rare manifestations. Early recognition and appropriate management in ED are crucial to prevent severe systemic complications in these patients.