Syphilitic gummas affecting brain and spinal cord: a case report

Syphilitic gumma is a rare manifestation of neurosyphilis that can cause mass lesions in the central nervous system. We present an atypical case of a 53-year-old man presenting with syphilitic gummas affecting both the brain and spinal cord. The patient presented with right facial numbness, worsening back pain, gait disturbances, and lower-limb weakness. Serological tests were positive for syphilis, and cerebrospinal fluid analysis showed elevated cell count, protein concentration, and positive syphilis tests. Brain and spinal cord MRI revealed dural-based enhancing mass lesions in the right middle cerebellar peduncle and conus medullaris. The patient underwent posterior decompression and biopsy of the conus medullaris. Histopathological findings excluded malignancy and were consistent with syphilitic gumma. The patient received intravenous benzylpenicillin, followed by oral amoxicillin, resulting in partial improvement of neurological symptoms and gradual regression of the lesions on follow-up MRI. This case highlights the importance of considering syphilitic gumma in the differential diagnosis of intracranial and spinal cord lesions in patients with syphilis. Prompt antibiotic treatment and serial MRI imaging are crucial for managing this condition.