[Multiple Spinal Intradural and Extradural Syphilis Granuloma Mimicking Lumbar Dumbbell Type Neurinoma:A Case Report]

Spinal intradural and extradural syphilis granuloma is extremely rare. Here, we report a patient with multiple spinal intradural and extradural syphilis granuloma mimicking dumbbell type neurinoma. The patient was a 68-year-old man, who presented with left femoral pain for a month. Magnetic resonance imaging(MRI)revealed a homogeneous enhanced dumbbell-shaped lesion occupying the spinal canal at the level of lumbar 3/4 and developing through the intervertebral foramen. Although initial blood tests revealed that he contracted with the syphilis, we diagnosed dumbbell type neurinoma preoperatively. He underwent partial tumor removal. The tumor adhered tightly to the cauda equina in intraoperative finding. Histopathological diagnosis of the lesion was granulomatous inflammation with the lymphocytic infiltration. Postoperatively, results of the Treponema pallidum hemagglutination(TPHA)test and the rapid plasma regain(RPR)test of cerebrospinal fluid were reactive, so we confirmed syphilis granuloma. He was treated with penicillin G for two weeks from 25 days after surgery. A follow-up MRI of the lumbar spine 51 days after surgery showed a reduction in size of the lumbar spinal tumor compared to the initial findings. Thus, syphilis granuloma should be considered in differential diagnosis of a spinal dumbbell shaped lesion. Penicillin G may be effective for the treatment of syphilis granuloma.