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In cases where the CSF-VDRL is nonreactive despite high clinical suspicion, CSF-Fluorescent Treponemal Antibody Absorption (FTA-ABS) or CSF-TPPA assays can enhance diagnostic sensitivity ( Radiologically, spinal neurosyphilis is typically characterized by long-segment T2 hyperintensity, predominantly affecting the dorsal columns, accompanied by myelitis-like changes and patchy enhancementfeatures notably absent in our patient

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However, the lack of FDA approval and potential quality control issues necessitate a cautious approach

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