Cerebral syphilitic gumma masquerading as cerebral metastatic tumors: case report

Abstract

<jats:p>A 45-year-old man was admitted with severe headache and left-sided weakness, which worsened over 1 week. Brain imaging revealed a small lesion close to the sagittal sinus in the right frontal lobe with severe perilesional edema and showed enhancement on both CT and MRI obtained with contrast. Serological findings were positive for toluidine red unheated serum test (TRUST) positivity and <jats:italic>Treponema pallidum</jats:italic> particle agglutination assay. The patient was first suspected of having a malignant brain tumor and subsequently received emergency craniotomy. Brain biopsy suggested a diagnosis of syphilitic cerebral gumma; meanwhile the postoperative CSF TRUST titer was positive, and the patient’s improvement with high-dose intravenous aqueous crystalline penicillin further supported this etiology. Finally, the lesion on the right frontal lobe had disappeared during the follow-up imaging examination and the myodynamia of the left limbs gradually improved. The authors recommend that diagnostic penicillin treatment should be first implemented. When a patient’s history, clinical manifestations, syphilis serology, CSF examination, and other physiological changes indicate a diagnosis of syphilitic cerebral gumma, there is no doubt that surgery should be performed in patients with acute intracranial hypertension, but unnecessary craniotomy should be avoided as far as possible.</jats:p>

Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male

“…Of the 25 rare cases of cerebral gummas or syphilitic mass-forming lesions to be reported in the last 10 years to our knowledge, ours is the first to report confirmation of syphilitic meningovascular disease that is associated with a mass-forming lesion through a combination of positive serum tests, pathologic findings, and 16S rRNA sequencing for T pallidum ( Table 1 ) [ 4–26 ]. While 24% of cases in the literature did not report CSF syphilis testing, the majority utilized traditional treponemal or nontreponemal testing, or a modified version of these tests such as the toluidine red unheated serum test [ 15 , 26 ]. PCR testing was used rarely, in <10% of cases, and ours was the only case to use 16S rRNA sequencing.…”

The Application of MR Spectroscopy and MR Perfusion in Cerebral Syphilitic Gumma: A Case Report

“…However, it was still difficult to differentiate between the diagnosis of cerebral syphilitic gumma and intracranial neoplasias due to the lack of specific MR characteristics. In clinical practice, cerebral syphilitic gumma is most commonly misdiagnosed as high-grade gliomas, metastatic tumors, or meningiomas, which leads to subsequent surgeries in the patients (Noel et al, 2011;Xia et al, 2017;Zhang et al, 2017;Li et al, 2019;Weng et al, 2019).…”