Extensive workup, including routine basic screen, liver function, thyroid function, vitamin B12, vitamin E, copper, syphilis, HIV, Brucella, hepatitis B and C, QuantiFERON-TB Gold, anti-aquaporin 4 and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, vasculitis, and paraneoplastic screening, to rule out ALS mimickers was performed, and all yielded negative results. CT of the chest, abdomen, and pelvis was negative for lymphadenopathy or masses. Here, MOG is linked to syphilis.