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Some cases received immunotherapy early because the presentation appeared autoimmune, only for neurosyphilis to later emerge as the unifying diagnosis and antimicrobial therapy to become decisive ( Discussion Three scenarios: mimic, overlap, and trigger These observations support an infectionautoimmunity interface rather than a strict dichotomy (Table 1)

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Furthermore, the expansion of pathobionts like Peptostreptococcus can generate detrimental metabolites (e.g., indole derivatives), which directly upregulate cartilage-degrading MMP-13 (2628)