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Shen X, Zhu Z, Li X, Zhang W, Zhang X, Zhang B. Contribution of advanced neuroimaging in diagnosis of cerebral syphilitic gumma: a case report. Front Neurosci 2024; 18:1442176. [PMID: 39206117 PMCID: PMC11349654 DOI: 10.3389/fnins.2024.1442176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
Background Cerebral syphilitic gumma is a rare intracranial infectious disorder. Without a clear history of syphilis and comprehensive serological examinations, it's challenging to diagnose it accurately prior to surgery through routine magnetic resonance imaging (MRI). Advanced neuroimaging techniques have been widely used in diagnosing brain tumors, yet there's limited report on their application in cerebral syphilitic gumma. This report presents a case of an elderly male patient with cerebral syphilitic gumma and analyzes its characteristics of advanced neuroimaging. Case presentation A 68-year-old male patient was admitted to our institution presenting with bilateral hearing loss complicated with continuing headaches without obvious cause. Laboratory tests indicated positive treponema pallidum. Conventional MRI showed nodules closely related to the adjacent meninges in bilateral temporal lobes. The patient underwent surgical resection of the nodule in the right temporal lobe due to the mass effect and the final pathological diagnosis revealed cerebral syphilitic gumma. Conclusions With the return of syphilis in recent years, accurate diagnosis of cerebral syphilitic gumma is a matter of great urgency. Advanced neuro-MRI can serve as a significant complement to conventional MRI examination.
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Affiliation(s)
- Xinyi Shen
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhengyang Zhu
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Li
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wen Zhang
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing, China
- Institute of Brain Science, Nanjing University, Nanjing, China
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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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3
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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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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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5
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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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Cui L, Liu J, Zhang W, Xu Z, Hou H. The Application of MR Spectroscopy and MR Perfusion in Cerebral Syphilitic Gumma: A Case Report. Front Neurosci 2020; 14:544802. [PMID: 33192243 PMCID: PMC7609909 DOI: 10.3389/fnins.2020.544802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
Cerebral syphilitic gumma is a rare disease and can be misdiagnosed as a common brain tumor when only conventional imaging results are adopted. Differentiating between syphilitic gumma and tumors may be achieved by applying advanced magnetic resonance (MR) techniques, such as MR spectroscopy and MR perfusion. However, the MR perfusion characteristics of cerebral syphilitic gumma have not been reported yet. Here, we report a case of cerebral syphilitic gumma in a 52-year-old woman and discuss the imaging features of conventional MR, MR spectroscopy, and MR perfusion. The results suggest that the application of MR spectroscopy and MR perfusion could provide additional information that contributes to the diagnosis of cerebral syphilitic gumma.
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Affiliation(s)
- Linyang Cui
- Department of Radiology, Weihai Central Hospital, Weihai, China
| | - Jie Liu
- Department of Radiology, Weihai Central Hospital, Weihai, China
| | - Wenjun Zhang
- Department of Radiology, Weihai Central Hospital, Weihai, China
| | - Zushan Xu
- Department of Radiology, Weihai Central Hospital, Weihai, China
| | - Hongjun Hou
- Department of Radiology, Weihai Central Hospital, Weihai, China
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