Syphilitic gummas affecting brain and spinal cord: a case report

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Neurosyphilis, a complication of syphilis infection, can present with diverse neurological manifestations.
• Syphilitic gummas are rare granulomatous masses resulting from tertiary syphilis, often affecting the central nervous system.
• Atypical presentations of neurosyphilis, such as gummas in both the brain and spinal cord, pose diagnostic challenges.

Purpose of the Study:

• To present an atypical case of syphilitic gummas involving both the brain and spinal cord.
• To emphasize the diagnostic considerations for central nervous system mass lesions in patients with syphilis.
• To illustrate the clinical course and management of neurosyphilitic gummas.

Main Methods:

• Case report of a 53-year-old male with neurological deficits.
• Diagnostic workup included serological tests, cerebrospinal fluid analysis, and magnetic resonance imaging (MRI) of the brain and spinal cord.
• Surgical decompression and biopsy of spinal lesions were performed, followed by antibiotic treatment.

Main Results:

• The patient presented with facial numbness, back pain, gait disturbance, and lower-limb weakness.
• MRI revealed dural-based enhancing mass lesions in the brain and spinal cord.
• Histopathology confirmed syphilitic gumma, excluding malignancy.
• Treatment with intravenous benzylpenicillin followed by oral amoxicillin resulted in partial neurological improvement and lesion regression on follow-up MRI.

Conclusions:

• Syphilitic gumma is a rare but important differential diagnosis for intracranial and spinal cord mass lesions, especially in patients with a history of syphilis.
• Early diagnosis and prompt antibiotic therapy are critical for managing neurosyphilitic gummas.
• Serial MRI monitoring is essential to assess treatment response and lesion regression.