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Liang N, Li LM, Fan YM. Answer to June 2024 Photo Quiz. J Clin Microbiol 2024; 62:e0125723. [PMID: 38864634 DOI: 10.1128/jcm.01257-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Read the full article for the answer.
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Affiliation(s)
- Ni Liang
- Department of Dermatology, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Liang-Ming Li
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Yi-Ming Fan
- Dermatology, Plastic and Cosmetic Surgery Center, the First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, Guangdong, China
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Ariza Hutchinson V, Shnawa A, Lerner DP, Wener K, Cervantes-Arslanian A, Burns JD. Gummatous Neurosyphilis With Transient Worsening of Neurological Symptoms After Treatment Initiation. Neurohospitalist 2023; 13:403-405. [PMID: 37701263 PMCID: PMC10494825 DOI: 10.1177/19418744231175564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
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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Affiliation(s)
- Valeria Ariza Hutchinson
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA
| | - Aya Shnawa
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA
| | - David P. Lerner
- Department of Neurology, SUNY Downstate Medical School, Brooklyn, NY, USA
- Department of Neurology, Brookdale Hospital and Medical Center, Brooklyn, NY, USA
| | - Kenneth Wener
- Division of Infectious Diseases, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Anna Cervantes-Arslanian
- Department of Neurology, Boston Medical Center, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Joseph D. Burns
- Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Neurology, Tufts University School of Medicine, Boston MA, USA
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Dasovic B, Ewa Borys, Schneck MJ. Granulomatous Diseases of the Central Nervous System. Curr Neurol Neurosci Rep 2022; 22:33-45. [PMID: 35138588 DOI: 10.1007/s11910-022-01173-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To discuss the pathophysiology, key clinical features, necessary diagnostic evaluation, and current treatment regimens for granulomatous diseases of the central nervous system. RECENT FINDINGS The diagnosis and management of granulomatous disease of the central nervous system has been revolutionized by advances in diagnostic imaging. Nevertheless, tissue and/or cerebrospinal fluid (CSF) sampling remains necessary to establish the diagnosis in most cases. Establishing a specific diagnosis is critical because treatment selection needs to focus on the granulomatous process centering on either antibiotic or immunosuppressive agents. Particular for non-infectious granulomatous disease more aggressive immunotherapies may help in clinical outcome. There are multiple non-infectious and infectious etiologies for granulomatous disease of the central nervous system. Clinical manifestations result from local structural invasion of granulomas or granulomatous inflammation of the blood vessels and meninges. Rapid diagnosis and specific treatment is essential.
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Affiliation(s)
- Braden Dasovic
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue Maguire Building Suite 2700, Maywood, IL, 60153, USA
| | - Ewa Borys
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue Maguire Building Suite 2700, Maywood, IL, 60153, USA
| | - Michael J Schneck
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, 2160 South First Avenue Maguire Building Suite 2700, Maywood, IL, 60153, USA.
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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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Worku D, Houston A, Cosgrove C, Byrne L. Spinal Syphilitic Gumma: A Rare Presentation of an Old Disease. Case Rep Infect Dis 2021; 2021:5533686. [PMID: 34188963 PMCID: PMC8192201 DOI: 10.1155/2021/5533686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Syphilis is an ancient condition which still is of global concern today. Despite better awareness amongst clinicians and improving diagnostics, it remains likely underdiagnosed in part because of its namesake the 'great imitator.' While many patients suffer primary or secondary disease, tertiary syphilis characterised by gumma is rare, especially in the context of neurosyphilis. Here, we report a rare case of a well-controlled human immunodeficiency virus- (HIV-) positive gentleman with a history of previous syphilis and epilepsy who presented with progressive left leg weakness leading to immobility and altered bowels and, on neurological examination, Brown-Sequard syndrome. Magnetic resonance imaging (MRI) of the spine revealed two peripherally enhancing cavitating lesions at T4-T5 with associated meningeal thickening and cord oedema. Cerebrospinal fluid (CSF) analysis revealed high protein (3.07 g/dL) and white cell count (7 × 109/L) with negative cryptococcal antigen, tuberculosis molecular testing (GeneXpert), microscopy and culture, and viral polymerase chain reaction (PCR). CSF serology was positive for Treponema pallidum particle agglutination (TPPA) 10240 and RPR 1 in 2 suggesting active disease. While TB treatment had been started prior to these investigations on day 11, 14-day high-dose benzylpenicillin therapy commenced. Repeat MRI of the spine at days 12 and 22 showed incremental improvements in all parameters which correlated with improving functionality and neurology. According to our literature search, this represents the 13th case recorded for spinal syphilitic gumma and the only case recorded in a HIV-positive individual and adds to the evidence that, in the absence of rapidly changing neurology, medical management can lead to good clinical outcomes.
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Affiliation(s)
- Dominic Worku
- Clinical Infection Unit, St. George's Hospital, BlackshawRoad, Tooting, London SW17 0QT, UK
| | - Angela Houston
- Clinical Infection Unit, St. George's Hospital, BlackshawRoad, Tooting, London SW17 0QT, UK
| | - Catherine Cosgrove
- Clinical Infection Unit, St. George's Hospital, BlackshawRoad, Tooting, London SW17 0QT, UK
| | - Laura Byrne
- Clinical Infection Unit, St. George's Hospital, BlackshawRoad, Tooting, London SW17 0QT, UK
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Thibodeau R, Goel A, Jafroodifar A, Klumpp M, Mirchia K, Swarnkar A. Cerebral syphilitic gumma presenting with intracranial gumma and pathologic vertebrae fractures. Radiol Case Rep 2021; 16:916-922. [PMID: 33613804 PMCID: PMC7878977 DOI: 10.1016/j.radcr.2021.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 10/28/2022] Open
Abstract
A 37-year-old female was admitted with worsening neurologic function. On arrival from an outside hospital, the patient was obtunded and intubated. Magnetic resonance imaging of the brain revealed nodular enhancement of the leptomeninges, intracranial osteolytic lesions, and diffuse vasogenic edema causing mass effect. Imaging of the thoracic spine revealed pathologic compression fractures of 4 thoracic vertebrae. On review of the patient's electronic medical record, the patient had previously received treatment for secondary syphilis with intramuscular benzathine penicillin G. Surgical biopsies of the frontal bone and dura showed diffuse, chronic inflammation while a biopsy of the adjacent brain parenchyma revealed replicating spirochetes. The patient was subsequently prescribed dexamethasone and benzathine penicillin G. She regained neurologic function but later signed out against medical advice without completing her treatment regimen.
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Affiliation(s)
- Ryan Thibodeau
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, 13210
| | - Atin Goel
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, 13210
| | - Abtin Jafroodifar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, 13210
| | - Matthew Klumpp
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, 13210
| | - Kavya Mirchia
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, 13210
| | - Amar Swarnkar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, 13210
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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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