Neurosyphilitic gumma in a homosexual man with HIV infection confirmed by polymerase chain reaction

Abstract

The brain gumma is a rare manifestation of the tertiary stage of syphilis. A case of neurosyphilitic gumma was confirmed by the Treponema pallidum polymerase chain reaction in a 46-year-old HIV-positive homosexual man. The patient presented with a severe headache and was hospitalized. A computed tomography scan was performed which revealed a left frontal lobe mass. Lymphoma was suspected. However, infectious disease diagnostics were performed on the cerebrospinal fluid that included investigations for syphilis and other microbiological agents such as Toxoplasma gondii. This revealed a reactive venereal disease research laboratory test, a reactive syphilis rapid plasma reagin and a reactive T. pallidum particle agglutination test. The patient was treated for syphilis till complete recovery.

Late-stage neurosyphilis presenting with severe neuropsychiatric deficits: diagnosis, therapy, and course of three patients

“…However, acute cerebral involvement (syphilitic meningitis or meningovasculitis) with symptoms such as headache, cranial nerve palsies, and/or stroke can indeed occur already in the early stage of syphilis, whereas late-stage neurosyphilis rather presents with neuropsychiatric symptoms, and can be divided into general paresis and tabes dorsalis [6]. Cerebral gummas can occur in both, early, and late stages of syphilis [7,8]. Marked neuropsychiatric deficits such as progressive dementia with signs of cerebral atrophy are considered characteristic for the parenchymal involvement in late-stage neurosyphilis, particularly in general paresis.…”

Neurosyphilis presenting with a stroke-like syndrome

“…PCR for detection of treponemal nucleic acids in the CSF has also been suggested to be useful and confirmatory 14. It has a sensitivity of 30–71% and a specificity of 93% 12 15–17…”

A case of tertiary syphilis manifested with multiple skin gummas

“…Эпидемия сифилиса ассоциирована с эпидемией ВИЧ-инфекции, что создает предпосылки для появления третичного сифилиса. В литературе за последние годы описано несколько случаев гуммозных поражений головного и спинного мозга [13][14][15], сифилитической аневризмы аорты [16], третичных сифилидов кожи и слизистых оболочек [8,[17][18][19][20] у больных с сочетанием сифилиса и ВИЧ-инфекции. С другой стороны, случаи третичных поражений кожи и слизистых у пациентов, не инфицированных ВИЧ, также были зарегистрированы в разных странах мира: в России [21,22], США [23,24], Франции [25], Португалии [26][27][28], Болгарии [29], Марокко [30,31], Индии [32], что дало некоторым исследователям повод говорить о возвращении, «ренессансе» третичного сифилиса [21,29].…”