Gummatous neurosyphilis in an elderly patient in the Australian outback: a case report

Abstract

Introduction Neurosyphilis is an infection caused by the spirochete Treponema pallidum, which causes infiltration and thickening of brain meninges. Despite being an Old World disease, the rates of infection continue to rise. This clinical challenge involves early and accurate diagnosis, as neurosyphilis masquerades with various clinical symptoms and is often missed during initial presentation to the hospital. A comprehensive history and clinical examination are essential to detect suspicious cases early for further cerebrospinal fluid examination and neuroimaging. Patients treated with benzylpenicillin for a specific duration often show promising clinical and cognitive improvement, thus emphasizing the need for constant vigilance in our day-to-day practice. Case presentation A 77-year-old Caucasian gentleman presented to our hospital repeatedly with multiple episodes of presyncope and cognitive impairment. He also demonstrated bilateral deafness, tabes dorsalis, and left sixth cranial nerve palsy. His cerebrospinal fluid examination showed a nonreactive venereal disease research laboratory test, and magnetic resonance imaging of the brain revealed a gumma. Conclusion The diagnosis of neurosyphilis in the elderly requires a combination of clinical vigilance and a high index of suspicion, along with multimodal investigations, including cerebrospinal fluid examination and brain imaging.

Epidemiologia da sífilis gestacional no Nordeste brasileiro: Uma análise dos dados de 2018 a 2021

“…Os sintomas costumam surgir de 10 a 20 anos após o início da infecção. Nessa fase, as manifestações clínicas podem incluir sífilis cardiovascular, como insuficiência aórtica ou aneurisma, além de gomas ou lesões granulomatosas que invadem o tecido local e estágios avançados da doença do sistema nervoso central (SNC) (Devanand & Sundararajan, 2021;Miller & Ladich, 2022).…”