Spinal Cord Syphilitic Gumma Presenting with Brown-Séquard Syndrome: A Case Report and Literature Review.

Abstract

BACKGROUND:

Spinal neurosyphilis manifesting as a solitary syphilitic gumma is exceedingly rare. There are non-specific imaging findings and challenges in the diagnosis of spinal syphilitic gumma, which could be easily misdiagnosed as tumor lesions and require surgical resection or biopsy.

CLINICAL PRESENTATION:

We report the case of a 45-year-old female patient who was diagnosed with Spinal syphilitic gumma. Our case is the first reported case of spinal cord syphilitic gumma with intradural-extramedullary and intramedullary involvement.

CONCLUSION:

Spinal syphilitic gumma exhibits diverse clinical manifestations, lacks specific imaging features, accompanied by the patient's history deliberately concealed. Since clinicians do not have sufficient knowledge about such rare cases, misdiagnosis and missed diagnosis will be likely. When there is clinical suspicion for spinal syphilitic gumma, clinicians should pay close attention to relevant medical history, carry out a comprehensive physical examination and specific serological tests and cerebrospinal fluid (CSF) analysis. In summary, in cases with stable neurologic conditions, a trial administration of intravenous penicillin with follow-up imaging may be the optimal treatment option, and in cases with rapid progression or acute exacerbation, a surgical resection together with systemic antibiotic treatment for syphilis after surgery may be the best treatment strategy.

• Authors: Yin-Hui Huang, Qing-Xiao Shi, Mian-Mian Xu, Chuan-Zhen Chen, Mei-Li Yang, Jun-Jing Li, Ya-Fang Chen, Zhi-Qiang Lin, You-Yu Lin
• Journal: Annals of clinical and laboratory science (Ann Clin Lab Sci) Vol. 49 Issue 2 Pg. 265-270 (Mar 2019) ISSN: 1550-8080 [Electronic] United States
• PMID: 31028074 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: © 2019 by the Association of Clinical Scientists, Inc.

Topics

• Adult
• Aged
• Brown-Sequard Syndrome (complications, diagnostic imaging)
• Female
• Humans
• Inflammation (pathology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neurosyphilis (complications, diagnostic imaging)
• Spinal Cord (diagnostic imaging, pathology)
• Treatment Outcome