Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male

Pham, Khanh; Gottesdiener, Lee; Simon, Matthew S.; Trzebucki, Alex; Maldarelli, Grace A; Cisse, Babacar; Lieberman, Joshua A.; DeHaan, Elliot; Pisapia, David

doi:10.1093/ofid/ofab455

Cited by 3 publications

(5 citation statements)

References 28 publications

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“…Mass lesions can develop in neurosyphilis. In addition to gummas (syphilitic mass lesions), a mass‐forming inflammatory lesion associated with meningovascular syphilis was reported 11 . In the current case, MRI revealed a brain mass in a young immunocompetent male, which was suspected to be a neoplastic lesion.…”

Section: Discussionmentioning

confidence: 60%

“…In addition to gummas (syphilitic mass lesions), a mass-forming inflammatory lesion associated with meningovascular syphilis was reported. 11 In the current case, MRI revealed a brain mass in a young immunocompetent male, which was suspected to be a neoplastic lesion. Histologically, the lesion comprised highly cellular, atypical lymphoplasmacytic infiltrates in the leptomeninges, the associated blood vessels, and the brain parenchyma.…”

Section: Discussionmentioning

confidence: 66%

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Epstein–Barr virus‐positive monoclonal lymphoplasmacytic proliferation associated with neurosyphilis in an immunocompetent patient: A case report

et al. 2023

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Syphilis is an infectious disease caused by the spirochete bacterium Treponema pallidum. Neurosyphilis results from the infection of the nervous system with Treponema pallidum, which can occur at any stage of syphilis. Neurosyphilis is often overlooked because of its rarity. Early‐stage neurosyphilis with brain mass formation is rare. We present a case of early‐stage neurosyphilis with prominent Epstein–Barr virus (EBV)‐positive monoclonal lymphoplasmacytic proliferation in an immunocompetent patient. A 36‐year‐old man presented with a chief complaint of a progressively worsening headache, a newly developed skin rash, and a fever. Magnetic resonance imaging showed a mass lesion, which measured 18 mm in diameter, in the left frontal lobe of the cerebrum. The patient underwent an emergency operation to remove the abscess. A pathological investigation revealed complex findings. There was an abscess in the cerebrum. Lymphoplasmacytic meningitis was also noted. In addition, a vaguely nodular lesion, which was composed of plasmacytoid and lymphoid cells, was observed around the abscess. Immunohistochemically, an anti‐Treponema pallidum antibody revealed numerous Treponemas around the abscess. In situ hybridization revealed that the plasmacytoid and lymphoid cells were Epstein–Barr encoding region (EBER)‐positive; κ‐positive cells were significantly more prevalent than λ‐positive cells, suggesting light‐chain restriction. Postoperatively, parenteral antibiotics were administered for four weeks. The patient has been free of recurrence for two years since the surgery. No association between neurosyphilis and EBV‐positive lymphoplasmacytic proliferation has ever been reported. Mass formation in early‐stage neurosyphilis is an exceptionally rare event. The present case indicates that in syphilis patients, lymphoproliferative disorders that lead to mass formation may be caused by concomitant EBV reactivation. Furthermore, when treating patients with mass lesions of the central nervous system, it is important to check their medical history and perform laboratory screening for infectious diseases to avoid overlooking syphilis infections.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 66%

Epstein–Barr virus‐positive monoclonal lymphoplasmacytic proliferation associated with neurosyphilis in an immunocompetent patient: A case report

et al. 2023

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“…It has been demonstrated in rabbit models, mouse models, and human subjects that T. pallidum is capable of invading the CNS early in the disease ( 21 ). Pham et al found T. pallidum in brain tissue, which was confirmed by 16S ribosomal RNA sequencing ( 22 ). Additionally, metagenomic next-generation sequencing (mNGS) detected T. pallidum nucleic acids in the CSF at low levels ( 23 ).…”

Section: The Mechanisms Of Invasion Of the Cns By T Pallidummentioning

confidence: 85%

Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention

Wu,

Ye,

Wang

et al. 2024

Front. Neurol.

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Background and aimInvasion of the central nervous system by Treponema pallidum can occur at any stage of syphilis. In the event that T. pallidum is not cleared promptly, certain individuals may experience progression to neurosyphilis, which manifests as cognitive and behavioral abnormalities, limb paralysis, and potentially fatal outcomes. Early identification or prevention of neurosyphilis is therefore crucial. The aim of this paper is to conduct a critical and narrative review of the latest information focusing exclusively to the pathogenesis and clinical management of neurosyphilis.MethodologyTo compile this review, we have conducted electronic literature searches from the PubMed database relating to neurosyphilis. Priority was given to studies published from the past 10 years (from 2013 to 2023) and other studies if they were of significant importance (from 1985 to 2012), including whole genome sequencing results, cell structure of T. pallidum, history of genotyping, and other related topics. These studies are classic or reflect a developmental process.ResultsNeurosyphilis has garnered global attention, yet susceptibility to and the pathogenesis of this condition remain under investigation. Cerebrospinal fluid examination plays an important role in the diagnosis of neurosyphilis, but lacks the gold standard. Intravenous aqueous crystalline penicillin G continues to be the recommended therapeutic approach for neurosyphilis. Considering its sustained prominence, it is imperative to develop novel public health tactics in order to manage the resurgence of neurosyphilis.ConclusionThis review gives an updated narrative description of neurosyphilis with special emphasis on its pathogenesis, susceptibility, diagnosis, treatment, and prevention.

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“…Cerebral syphilitic gumma is a rare manifestation of meningovascular syphilis and usually presents as a mass lesion mimicking malignant primary or metastatic tumors. 1,2 Pathologically, cerebral gummas are granulomatous nodules composed of lymphocytes and plasma cells that forms from pia mater. T. pallidum can be observed in these lesions using immunofluorescence or silver staining.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral syphilitic gumma is a rare manifestation of meningovascular syphilis and usually presents as a mass lesion mimicking malignant primary or metastatic tumors. 1,2…”

Section: Discussionmentioning

confidence: 99%

Gummatous Neurosyphilis With Transient Worsening of Neurological Symptoms After Treatment Initiation

Hutchinson

Shnawa

Lerner

et al. 2023

The Neurohospitalist

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Cerebral syphilitic gumma is an atypical presentation of neurosyphilis, the clinical manifestations of which depend on the size and location of the lesions. It radiologically presents as enhancing nodular lesion(s) in brain parenchyma. We present a case of a patient with cerebral syphilitic gummas who had worsening neurological symptoms a few hours after initiation of anti-syphilitic antibiotic treatment. We aim to illustrate the clinical and radiological characteristics that might be helpful to clinicians when approaching the challenges they might encounter while treating neurosyphilis.

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Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male

Cited by 3 publications

References 28 publications

Epstein–Barr virus‐positive monoclonal lymphoplasmacytic proliferation associated with neurosyphilis in an immunocompetent patient: A case report

Epstein–Barr virus‐positive monoclonal lymphoplasmacytic proliferation associated with neurosyphilis in an immunocompetent patient: A case report

Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention

Gummatous Neurosyphilis With Transient Worsening of Neurological Symptoms After Treatment Initiation

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