Neurosyphilis revealed by compressive cervical spine syphilitic gumma: a case report

Mejdoubi, Anasse; Khoulali, Mohamed; Raouzi, Nabil; Nasri, Siham; Mebrouk, Yassine; Oulali, Noureddine; Moufid, Fayçal

doi:10.1038/s41394-020-0303-8

Cited by 9 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In patients with penicillin allergy, intravenous administration of ceftriaxone at 2 g/day for 14 days is an alternative regimen. 1,6,8,9) In the present case, we made a judgement of emergent decompression of the spinal cord by lesionectomy because the patient presented with complete paralysis of the legs after a few days due to the strong distortion of the spinal cord by the gumma. Previous studies reported that CNS syphilitic gumma was reduced by standard penicillin therapy, thereby avoiding unnecessary surgeries.…”

Section: Discussionmentioning

confidence: 92%

“…Previous studies reported cases of spinal syphilitic gumma that was not suspected prior to surgery; however, after postoperative histopathological examination suggested the possibility of spinal syphilitic gumma, it was definitively diagnosed by syphilis-positive findings in an additional serological test for syphilis. 8,13) Spinal syphilitic gumma is difficult to diagnose, and although CSF examinations are useful to diagnose CNS syphilitic gumma, negative results in CSF examinations cannot exclude the possibility of CNS syphilitic gumma. 2,12) Antibiotic treatment of syphilis is based on stage of infection and whether there is evidence of CNS involvement.…”

Section: Discussionmentioning

confidence: 99%

“…6,12) However, since antibiotic treatment takes time until CNS syphilitic gumma is reduced, decompression of the spinal cord by lesionectomy should be prioritized and antibiotic treatment performed after histopathological diagnosis in cases with rapid progression of neurological deterioration. 8,15) In the present case, intravenous administration of ceftriaxone was selected as the postoperative antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Multiple Spinal Syphilitic Gummas Diagnosed by Postoperative Histopathology and Antibiotic Responsiveness: A Case Report

Niimura

Imai

2021

NMC Case Report Journal

View full text Add to dashboard Cite

Neurosyphilis is an infection of the central nervous system by Treponema pallidum. Gummatous neurosyphilis, especially spinal syphilitic gumma, is an exceedingly rare manifestation and may be misdiagnosed as other tumors due to its rarity. A 42-year-old man with a medical history of treatment for syphilis presented with rapidly progressive leg paralysis, leg sensory disturbance, and bladder and rectal disturbance. Spinal MRI demonstrated an intradural extramedullary lesion strongly compressing the spinal cord at the T6/7 level, which was accompanied with dural tail sign and perilesional meningeal thickening at the T6-T8 levels. Small intradural extramedullary lesions were also detected at the T1 and T8 levels. Serological and cerebrospinal fluid examinations for syphilis were both positive. In the treatment of spinal syphilitic gumma, the decompression of the spinal cord by lesionectomy followed by postoperative antibiotic treatment is considered to be an optimal procedure in patients with rapid progression of neurological deterioration. In the present case, the symptomatic main lesion that was compressing the thoracic cord was excised by surgery and analyzed by histopathological examination, and another small asymptomatic lesion was resolved by postoperative antibiotic treatment. Spinal syphilitic gumma was diagnosed using both histopathological findings of the surgically resected lesion and another residual lesion that was resolved by postoperative antibiotic treatment.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multiple Spinal Syphilitic Gummas Diagnosed by Postoperative Histopathology and Antibiotic Responsiveness: A Case Report

Niimura

Imai

2021

NMC Case Report Journal

View full text Add to dashboard Cite

show abstract

“…Our approach mirrored recent BASH guidelines which suggest 2.4 g benzylpenicillin over 14 days. Commonly, steroids are given during the first 3 days starting 24 hours prior to the initiation of penicillin therapy to prevent Jarisch–Herxheimer reaction [ 4 , 7 , 10 , 17 , 18 ]. At present, resolution of CSF abnormalities evaluated at 6-month intervals is seen as the best means to determine cure with serological cure considered as a four-fold decline in CSF-TPHA titres within 12 months of therapy [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…Common findings include CSF pleocytosis, hyperproteinorrachia, oligoclonal bands, and increased IgG. While these are considered nonspecific markers of neurosyphilis, CSF serology in particular Venereal Disease Research Laboratory (VDRL) antibody is considered the gold standard; however, this remains an area of debate [6][7][8]. One rare presentation of tertiary syphilis is the formation of gumma which, historically, could be seen in up to 1 in 3 with untreated disease.…”

Section: Introductionmentioning

confidence: 99%

Spinal Syphilitic Gumma: A Rare Presentation of an Old Disease

Worku

Houston

Cosgrove

et al. 2021

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

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.

show abstract

Complete bone fusion in failed back surgery syndrome using teriparatide in neurosyphilis: A case report

Lim¹

2022

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

Neurosyphilis revealed by compressive cervical spine syphilitic gumma: a case report

Cited by 9 publications

References 17 publications

Multiple Spinal Syphilitic Gummas Diagnosed by Postoperative Histopathology and Antibiotic Responsiveness: A Case Report

Multiple Spinal Syphilitic Gummas Diagnosed by Postoperative Histopathology and Antibiotic Responsiveness: A Case Report

Spinal Syphilitic Gumma: A Rare Presentation of an Old Disease

Complete bone fusion in failed back surgery syndrome using teriparatide in neurosyphilis: A case report

Contact Info

Product

Resources

About