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Intern Med. 2017 July 1; 56(13): 1747–1748.
PMCID: PMC5519484

Pontine Syphilitic Gumma in an HIV-negative Patient

The patient was a 24-year-old man who presented with a 2-month history of headache, gait disturbance and hearing loss. He had no skin or genital manifestations before these symptoms. T2-weighted magnetic resonance imaging (MRI), fluid-attenuated inversion recovery MRI, contrast-enhanced T1-weighted MRI, and diffusion-weighted MRI revealed a mass with extensive edema and dural enhancement in the pons (Picture, respectively). No abnormalities were observed in other regions. Examinations of the patient's serum and cerebrospinal fluid revealed pleocytosis (1,437/mm3), and a rapid plasma regain (RPR) test and treponema pallidum latex agglutination test yielded positive results. The patient's serum was negative for anti-human immunodeficiency virus (HIV) antibodies. Based on the above results, the patient was diagnosed with cerebral syphilitic gumma. Treatment with high-dose intravenous penicillin G followed by oral 3 months of treatment with doxycycline relieved the patient's symptoms, reduced the RPR titers and improved his MRI findings. Cerebral gumma occasionally occurs in patients without prodromal symptoms or anti-HIV antibodies and rarely appears in the pons (1, 2). In such cases, cerebral gumma should be considered.

The authors state that they have no Conflict of Interest (COI).

Acknowledgement

Dr. Shibuya receives grant aid from Magnetic Health Science Foundation. Kuwabara receives research support from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

References

1. Fargen KM, Alvernia JE, Lin CS, Melgar M Cerebral syphilitic gummata: a case presentation and analysis of 156 reported cases. Neurosurgery 64: 568-575, 2009. [PubMed]
2. Golden MR, Marra CM, Holmes KK Update on syphilis: resurgence of an old problem. JAMA 290: 1510-1514, 2003. [PubMed]

Articles from Internal Medicine are provided here courtesy of Japanese Society of Internal Medicine