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Peel J, Blazos M, Manuchehri H, Fish C, Griffin DWJ. Frontal Lobe Lesion Masquerades as Meningioma. Clin Infect Dis 2023; 77:1733-1735. [PMID: 38102806 DOI: 10.1093/cid/ciad521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- Joanne Peel
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Mitsi Blazos
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Hossein Manuchehri
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Australia
| | - Charles Fish
- Department of Neurosurgery, Alfred Hospital, Melbourne, Australia
| | - David W J Griffin
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
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Liu H, Dong D. MRI of neurosyphilis with mesiotemporal lobe lesions of "knife-cut sign” on MRI: A case report and literature review. Heliyon 2023; 9:e14787. [PMID: 37025798 PMCID: PMC10070661 DOI: 10.1016/j.heliyon.2023.e14787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Neurosyphilis with mesiotemporal lobe lesions remains a difficult entity to diagnose, especially when it mimics herpes simplex encephalitis (HSE). Here, we report what appeared to be the first case of mesiotemporal imaging of neurosyphilis presenting as a "knife-cut" sign and mimicking HSE pathological hallmarks on imaging. The magnetic resonance imaging (MRI) changes in neurosyphilis and HSE were indistinguishable in the initial diagnosis because of the common involvement of the mesiotemporal lobe. Neurosyphilis was diagnostically confirmed by positive readings in the treponema pallidum hemagglutination assay (TPHA), rapid plasma reagin (RPR) and cerebrospinal fluid-polymerase chain reaction (CSF-PCR) tests for Treponema pallidum infection. Neurosyphilis and HSE had similar clinical features and signs on MRI, except the knife-cut sign which is a common diagnosis in HSE. Therefore, neurosyphilis with mesiotemporal changes and knife-cut signs on MRI should be evaluated in the differential diagnosis in all patients, as similar changes may also occur in HSE patients. The literature review of published articles between 1997 and 2020 was conducted to further validate our clinical observations and discuss diagnostic and treatment options for neurosyphilis with mesiotemporal lobe lesions.
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Kanayama S, Nagata S, Akiyama Y, Miyazato Y, Ishikane M, Inoue M, Ohmagari N, Hara T. Cerebral syphilitic Gumma in the modern era: a report of an unusual case and brief review of recent published reports. Br J Neurosurg 2022:1-6. [PMID: 36564899 DOI: 10.1080/02688697.2022.2159923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/21/2021] [Accepted: 09/08/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cerebral syphilitic gummas are rare. However, numerous case reports on them have been published recently, consistent with the resurgence of syphilis and its accompanying atypical manifestations. We here present a patient with a cerebral syphilitic gumma and an unusual clinical course and review recent case reports. CASE PRESENTATION A 49-year-old woman had a generalised seizure and was found by computed tomography and magnetic resonance imaging to have a brain mass that mimicked a brain abscess or malignant tumour. Further imaging with magnetic resonance spectroscopy and positron emission tomography did not contribute further to the differential diagnosis. Because treatment with ceftriaxone was ineffective, the lesion was resected. Serological tests on serum and cerebrospinal fluid were positive for syphilis and histopathological examination of the operative specimen revealed a syphilitic gumma. Antibiotic treatment is preferred over invasive interventions for cerebral syphilitic gumma. However, as in our case, radical resection is required when antibiotic treatment is ineffective. CONCLUSIONS It has recently been reported that the prevalence of syphilis is increasing in older individuals, including in patients without HIV infection or prior treatment for early syphilis. Though advanced imaging and molecular biological techniques are often used to help make a diagnosis, they are of limited value. Because the clinical and imaging features are nonspecific, some neurosurgeons do not include cerebral syphilitic gummas in their differential diagnoses. It is vital that this possibility be considered when a patient has a tumour-like cerebral mass and serum positivity for syphilis.
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Affiliation(s)
- Seisaku Kanayama
- Department of Neurosurgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
| | - Soudai Nagata
- Department of Neurosurgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaro Akiyama
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masato Inoue
- Department of Neurosurgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuo Hara
- Department of Neurosurgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan
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Jankowska L, Adamski Z, Polańska A, Bowszyc-Dmochowska M, Plagens-Rotman K, Merks P, Czarnecka-Operacz M, Żaba R. Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16992. [PMID: 36554872 PMCID: PMC9778711 DOI: 10.3390/ijerph192416992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Tertiary syphilis is a large diagnostic challenge. It is rarely the case that it affects the skin, bone tissue and the eyes at the same time. The presented case shows that extensive symptomatology of syphilis poses a challenge in making a proper diagnosis in patients whose history does not suspect STDs. The study aims to present the case of a young woman hospitalized with a suspected autoimmune disease, diagnosed with symptomatic late syphilis with involvement of the skin, bones and eyes.
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Affiliation(s)
- Lucyna Jankowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Katarzyna Plagens-Rotman
- Center for Pediatric, Adolescent Gynecology and Sexology Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
| | - Magdalena Czarnecka-Operacz
- Allergic and Occupational Skin Diseases Unit, Department of Dermatology, Medical University of Poznań, 60-355 Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Jum'ah A, Aboul Nour H, Alkhoujah M, Zoghoul S, Eltous L, Miller D. Neurosyphilis in disguise. Neuroradiology 2021; 64:433-441. [PMID: 34665270 DOI: 10.1007/s00234-021-02827-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Neurosyphilis can mimic different diseases, not only in its clinical presentation but also on imaging. Treponema pallidum is also known as the "great imitator." Having an ultimate diagnosis of neurosyphilis is quite critical as this can affect management drastically. Herein, we discuss the case of a 69-year-old female who was treated for neurosyphilis, while having an atypical imaging finding of anterior temporal lobe enhancement that simulated an infection with herpes simplex virus (HSV); we also review the available literature on different imaging findings in both the early and late stages of the disease. METHODS We performed a literature search using the new PubMed in June 2021. The terms "neurosyphilis", "MRI", and "neuroimaging" were used either alone or in combination with "early neurosyphilis" or "late neurosyphilis". Data on neurosyphilis and imaging findings was mainly derived from review articles, cohort studies, case series, and individual reports. CONCLUSION Neurosyphilis can present with an extensive variation and different patterns on the MRI, and clinicians must be aware of the wide variety in radiological presentations. Anterior temporal lobe involvement is a rare presentation and requires evaluating for neurosyphilis to prevent a missed diagnosis and treatment.
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Affiliation(s)
- Ammar Jum'ah
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA.
| | - Hassan Aboul Nour
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA
| | - Mohammad Alkhoujah
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA
| | - Sohaib Zoghoul
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Lara Eltous
- Jordan University of Science and Technology, Irbid, Jordan
| | - Daniel Miller
- Department of Neurology, Henry Ford Hospital, 1350 W. Bethune St, Detroit, MI, 48202, USA
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Pham K, Gottesdiener L, Simon MS, Trzebucki A, Maldarelli GA, Cisse B, Lieberman J, DeHaan E, Pisapia D. Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male. Open Forum Infect Dis 2021; 8:ofab455. [PMID: 34557566 PMCID: PMC8454516 DOI: 10.1093/ofid/ofab455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022] Open
Abstract
We present a case of a human immunodeficiency virus-negative man with syphilitic meningovascular disease with subjacent involvement of brain parenchyma leading to a mass-forming inflammatory lesion that was pathologically distinct from a typical gumma. Syphilis was diagnosed after tissue obtained from a brain biopsy demonstrated spirochetes consistent with Treponema pallidum and confirmed by 16S ribosomal RNA sequencing.
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Affiliation(s)
- Khanh Pham
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Correspondence: Khanh Pham, MD, New York–Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, A-421, New York, NY 10021, USA ()
| | - Lee Gottesdiener
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Matthew S Simon
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alex Trzebucki
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Grace A Maldarelli
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Babacar Cisse
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Joshua Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Elliot DeHaan
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Pisapia
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Pathology, Weill Cornell Medicine, New York, New York, USA
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Barthel L, Hetze S, Teuber-Hanselmann S, Chapot V, Sure U. Syphilitic Gummata in the Central Nervous System: A Narrative Review and Case Report about a Noteworthy Clinical Manifestation. Microorganisms 2021; 9:906. [PMID: 33922782 PMCID: PMC8145658 DOI: 10.3390/microorganisms9050906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/12/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022] Open
Abstract
Infection with Treponema pallidum is on the rise. In this narrative literature review, we show that the incidence of rare manifestations of syphilis, such as intracerebral gummata, is increasing and should be considered in the differential diagnosis of intracerebral lesions. With the exemplary case that we present here, we aim to raise awareness of the resurgence of this disease, which should be considered in the differential diagnosis of intracerebral lesions, especially for patients who have a risk profile for syphilis, and serological testing for T. pallidum prior to surgery should be discussed in order to avoid an unnecessary operation.
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Affiliation(s)
- Lennart Barthel
- Department of Neurosurgery, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Susann Hetze
- Department of Neurosurgery, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Sarah Teuber-Hanselmann
- Institute of Neuropathology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Valérie Chapot
- Institute of Medical Microbiology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
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