NEUROSYPHILIS PRESENTING AS FECAL INCONTINENCE. E. Schmidt 1 , B. Mathis 1 , E. Warm 1 ; 1 University of Cincinnati, Cincinnati, OH (Tracking ID #74057) LEARNING OBJECTIVES: 1) Recognize various manifestations of tertiary syphilis. 2) Recognize treatment benefits of neurosyphilis. 3) Recognize that cases of tertiary syphilis may increase in prevalence in the clinic setting following the rise in cases of early syphilis seen in the past two decades. CASE INFORMATION: A 66 year-old African American male with history of treated syphilis at age 25 presented to an outpatient clinic following a hospital stay for recent subcortical stroke and non-Q wave myocardial infarction. He reported fecal and urinary incontinence and subjective memory deterioration for an undetermined amount of time. On exam he was found to have no anal sphincter tone and was unkempt. The patient was admitted to the hospital, and had a spine MRI that was negative for any lesions. He was found to have a SED rate of 117 mm/h, a positive RPR with a 1:1024 titer, and a positive serum FTA-Abs. Lumbar puncture revealed a pleocytosis with a predominance of lymphocytes, an elevated protein at 152 mg/dL, and a positive VDRL at 32 dilutions. The patient was treated for neurosyphilis with 14 days of intravenous penicillin G, 24 million units per day. He subsequently was found to be HIV positive. On clinic follow up, the patient had improved anal sphincter tone, improved physical appearance, and improved subjective cognition. His weight improved by 13 pounds and his RPR had decreased to a titer of 1:512. IMPLICATIONS/DISCUSSION: The patient described above had clear benefit of treatment with apparent reversal of some of the neurologic sequelae of his tertiary syphilis. There is lack of data in the literature supporting reversibility of the neurologic complications of this disease, especially the dementia, that is thought to be related to fibrosis, and therefore the thought of the RPR as a screening test for reversible causes of dementia has been questioned. It has been proposed that there may be an increase in the number of cases of tertiary syphilis in light of the increased number of primary syphilis cases seen in the past two decades, as well as an increase in the HIV population. There must be a heightened level of suspicion for this process in anyone with neurologic findings and history consistent with this diagnosis.