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

doi:10.1038/s41394-020-0303-8

Case Reports

. 2020 Jun 30;6(1):56.

doi: 10.1038/s41394-020-0303-8.

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

Anasse Mejdoubi¹, Mohamed Khoulali², Nabil Raouzi², Siham Nasri³, Yassine Mebrouk⁴, Noureddine Oulali², Fayçal Moufid²

Affiliations

¹ Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco. anasse.mejdoubi@gmail.com.
² Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.
³ Department of Radiology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.
⁴ Department of Neurology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.

PMID: 32606288
PMCID: PMC7324907
DOI: 10.1038/s41394-020-0303-8

Case Reports

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

Anasse Mejdoubi et al. Spinal Cord Ser Cases. 2020.

. 2020 Jun 30;6(1):56.

doi: 10.1038/s41394-020-0303-8.

Authors

Anasse Mejdoubi¹, Mohamed Khoulali², Nabil Raouzi², Siham Nasri³, Yassine Mebrouk⁴, Noureddine Oulali², Fayçal Moufid²

Affiliations

¹ Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco. anasse.mejdoubi@gmail.com.
² Department of Neurosurgery, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.
³ Department of Radiology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.
⁴ Department of Neurology, University Hospital Center Mohammed VI, Faculty of Medicine, Mohammed First University, Oujda, Morocco.

PMID: 32606288
PMCID: PMC7324907
DOI: 10.1038/s41394-020-0303-8

Abstract

Introduction: Neurosyphilis is a sexually transmitted disease secondary to the invasion of the central nervous system by the Treponema pallidum. The spinal syphilitic gumma is rare.

Case presentation: We report a case of extradural cervical spinal syphilitic gumma revealed by spinal cord compression in a 58-year-old male. The epidural lesion was removed via a posterior approach. Histological examination revealed syphilis. Syphilis serologies were positive. Brain MRI showed an associated cerebro-meningeal syphilitic gumma. Antibiotic regime based on aqueous penicillin G was introduced for 14 days.

Discussion: Currently, there is an increase in the frequency of syphilis and changes in its clinical manifestations. Neurosyphilis can take atypical forms. Spinal syphilitic gumma is a rare manifestation and its association with cerebral involvement is exceptional. Diagnosis is based on serologies in the blood and cerebrospinal fluid. The place of imagery, especially magnetic resonance imaging, is essential. Neurosyphilis should be discussed as a possible differential diagnosis in evaluation of spinal and cerebral lesions.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1. Cervical spinal MRI.**
a Sagittal T1-weighted image shows a posterior hypointense lesion next to C5. b Sagittal T2-weighted image shows a hypointense lesion. c Sagittal T1-weighted gadolinium-enhanced image shows homogeneous enhancement. d Axial T2-weighted image and e axial T1-weighted gadolinium-enhanced image shows a lesion occupying the posterior epidural space compressing the spinal cord.

**Fig. 2. Intraoperative image.**
Intraoperative aspect after dissection of the lesion from the dura mater.

**Fig. 3. Brain MRI.**
a Hypointense nodular lesion on sagittal T1-weighted image. b Hypointense lesion on sagittal T2-weighted image. c Perilesional edema on the FLAIR sequence. d Sagittal T1-weighted gadolinium-enhanced image, e, f axial T1-weighted gadolinium-enhanced image sh.

See this image and copyright information in PMC

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References

1. Mitsonis C, Kararizou E, Dimopoulos N, Triantafyllou N, Kapaki E, Mitropoulos P, et al. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci. 2008;118:1251–7. doi: 10.1080/00207450701239426. - DOI - PubMed
1. Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, et al. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci. 2019;69:67–73. doi: 10.1016/j.jocn.2019.08.033. - DOI - PubMed
1. Salem KMI, Majeed H, Bommireddy R, Klezl Z. Tertiary syphilis in the cervical spine: a case report and review of the literature. Glob Spine J. 2013;3:041–6. doi: 10.1055/s-0032-1329887. - DOI - PMC - PubMed
1. Cui L, Xu Z, Hou H. Diagnosis and treatment of spinal syphilitic gumma: a case report. Front Neurol. 2020;10:1–4. doi: 10.3389/fneur.2019.01352. - DOI - PMC - PubMed
1. Huang YH, Shi QX, Xu MM, Chen CZ, Yang ML, Li JJ, et al. Spinal cord syphilitic gumma presenting with brown-Séquard syndrome: a case report and literature review. Ann Clin Lab Sci. 2019;49:265–70. - PubMed

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[1] Mitsonis C, Kararizou E, Dimopoulos N, Triantafyllou N, Kapaki E, Mitropoulos P, et al. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci. 2008;118:1251–7. doi: 10.1080/00207450701239426. - DOI - PubMed

[2] Mitsonis C, Kararizou E, Dimopoulos N, Triantafyllou N, Kapaki E, Mitropoulos P, et al. Incidence and clinical presentation of neurosyphilis: a retrospective study of 81 cases. Int J Neurosci. 2008;118:1251–7. doi: 10.1080/00207450701239426. - DOI - PubMed

[3] Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, et al. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci. 2019;69:67–73. doi: 10.1016/j.jocn.2019.08.033. - DOI - PubMed

[4] Skalnaya A, Fominykh V, Ivashchenko R, Averchenkov D, Grazhdantseva L, Frigo N, et al. Neurosyphilis in the modern era: Literature review and case series. J Clin Neurosci. 2019;69:67–73. doi: 10.1016/j.jocn.2019.08.033. - DOI - PubMed

[5] Salem KMI, Majeed H, Bommireddy R, Klezl Z. Tertiary syphilis in the cervical spine: a case report and review of the literature. Glob Spine J. 2013;3:041–6. doi: 10.1055/s-0032-1329887. - DOI - PMC - PubMed

[6] Salem KMI, Majeed H, Bommireddy R, Klezl Z. Tertiary syphilis in the cervical spine: a case report and review of the literature. Glob Spine J. 2013;3:041–6. doi: 10.1055/s-0032-1329887. - DOI - PMC - PubMed

[7] Cui L, Xu Z, Hou H. Diagnosis and treatment of spinal syphilitic gumma: a case report. Front Neurol. 2020;10:1–4. doi: 10.3389/fneur.2019.01352. - DOI - PMC - PubMed

[8] Cui L, Xu Z, Hou H. Diagnosis and treatment of spinal syphilitic gumma: a case report. Front Neurol. 2020;10:1–4. doi: 10.3389/fneur.2019.01352. - DOI - PMC - PubMed

[9] Huang YH, Shi QX, Xu MM, Chen CZ, Yang ML, Li JJ, et al. Spinal cord syphilitic gumma presenting with brown-Séquard syndrome: a case report and literature review. Ann Clin Lab Sci. 2019;49:265–70. - PubMed

[10] Huang YH, Shi QX, Xu MM, Chen CZ, Yang ML, Li JJ, et al. Spinal cord syphilitic gumma presenting with brown-Séquard syndrome: a case report and literature review. Ann Clin Lab Sci. 2019;49:265–70. - PubMed

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

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

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