Cerebral syphilitic gumma misdiagnosed as glioma: A case report and literature review

Huo, Kun-liang; Liu, Luo-tong; Yang, Ming; Jing, Huai-song; Chen, Ligang

doi:10.4103/0028-3886.111137

Cited by 7 publications

(3 citation statements)

References 1 publication

(3 reference statements)

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“…The information about the history of the patients' therapy was scarce as well. In particular, only six patients (2%) reported a certain previous treatment for syphilis, but for two of them it was unclear whether such therapy was completed and even if it was a standard one . A total of 171 patients, that is, 60%, denied the occurrence of previous skin or mucous lesions; so we must assume that they have not received any therapy for early syphilis.…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, the suggestion that a standard therapy with penicillin G benzathine (BPG) in early syphilis may not be sufficient to prevent NS, has been already advanced and supported by cases of BPG failures and by late complications in immunocompetent patients adequately treated for early disease . In a recent study, 17 patients progressed to NS despite appropriate treatments and serological response understood as of a fourfold decrease in their RPR titres within 6 months from therapy .…”

Section: Discussionmentioning

confidence: 99%

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Changes in neurosyphilis presentation: a survey on 286 patients

Drago

Merlo

Ciccarese

et al. 2016

Acad Dermatol Venereol

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Although neurosyphilis (NS) keeps plaguing worldwide, often with oligosymptomatic and atypical manifestations, the most recent reports fail to provide useful information, like details of the clinical history and even of the previous early therapy. We conducted a survey of the literature of the last 5 years on the clinical presentation of NS, recording the aforementioned inaccuracies. One hundred and thirty-seven articles were collected, reporting on 286 patients. General paresis was the commonest form (49%), often manifesting with cognitive impairment and psychiatric symptoms. Syphilitic meningitis was found in 63 patients (22%), mainly with ocular or auditory involvement. Meningovascular and tabetic form were both found in 12% of cases. Gummatous and epileptic manifestations were rare. Perusal of the literature confirms that NS prevalence is increasing, often with manifestations that are atypical for timing and type of lesions. Unfortunately, many articles are lacking of critical information, like an accurate clinical history and timing of the therapy making difficult to assess the effectiveness of penicillin in preventing NS.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Changes in neurosyphilis presentation: a survey on 286 patients

Drago

Merlo

Ciccarese

et al. 2016

Acad Dermatol Venereol

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“…Because cerebral syphilitic gumma causes typical clinical symptoms and the lesions exhibit diverse characteristics on imaging, the lesions can be easily confused with brain tumors. For these reasons, syphilitic gumma often cannot be diagnosed before surgery and can only be pathologically confirmed after the operation (Ances et al, 2005 ; Darwish et al, 2008 ; Li et al, 2012 ; Ventura et al, 2012 ; Huo et al, 2013 ; Shi et al, 2017 ; Zhang et al, 2017 ). This study reported three cases of cerebral syphilitic gumma.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Cerebral Syphilitic Gumma: A Report of Three Cases

et al. 2018

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Cerebral syphilitic gumma is very rare and is often pathologically confirmed following surgery. This study reports three patients with cerebral syphilitic gumma. The first case was a 62-year-old man who was admitted to our hospital due to speech arrest for 10 hours. Head MRI showed a nodular signal shadow with a significant enhancement and a significant centerline shift. He subsequently received surgery, and cerebral syphilitic gumma was confirmed by postoperative pathology. The second patient was a 66-year-old man who was admitted to our hospital due to complaints of gradually decreasing right eye vision and headache for nearly 50 days. Enhanced MRI at admission indicated irregular clumping of high-signal mixed with low-signal foci on the frontal lobe. Subsequently, he was operatively treated and was confirmed to have cerebral syphilitic gumma by postoperative pathology. The third patient was a 37-year-old man who was admitted to our hospital due to dizziness for approximately 15 days. Head MRI indicated a slightly abnormal lamellar and longer T1, T2 signal shadow on the left side. He did not receive surgery, and his symptoms disappeared after anti-syphilitic treatment. Hence, we recommend a critical interpretation of preoperative imaging data, understanding the unique changes that arise in the brain that can be detected through imaging, and an analysis of the patient history and laboratory tests to re-evaluate the value of surgery, with the ultimate goal of performing a stabilizing treatment for cerebral syphilitic gumma.

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Neurosyphilis Update: Atypical is the New Typical

Bhai

Lyons

2015

Curr Infect Dis Rep

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Syphilis has reemerged as an important cause of neurological disease, affecting any part of the neuraxis at any stage of infection. What was once a dwindling diagnosis is now redoubling, particularly in the HIV-positive and in men who have sex with men populations. In the era of antibiotics and HIV coinfection, neurosyphilis presentations are protean, making diagnosis notoriously challenging. Advanced disease may be irreversible, and so early detection and treatment are ideal. Herein, we review recent advances in understanding neurosyphilis.

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Cerebral syphilitic gumma misdiagnosed as glioma: A case report and literature review

Cited by 7 publications

References 1 publication

Changes in neurosyphilis presentation: a survey on 286 patients

Changes in neurosyphilis presentation: a survey on 286 patients

Diagnosis and Treatment of Cerebral Syphilitic Gumma: A Report of Three Cases

Neurosyphilis Update: Atypical is the New Typical

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