A rare case of early‑onset cerebral syphilitic gummata with severe neurological decline in early‑stage syphilis: A case report

Cerebral syphilitic gummata are rare granulomatous lesions associated with tertiary syphilis, typically developing several years after the initial infection. Early-stage syphilis with cerebral gummata and accompanying severe neurological symptoms is rare. Failure to recognize the lesions or delays in diagnosis may lead to marked and potentially irreversible central nervous system injury. In the present study, the case of a 60-year-old man with a 6-month history of syphilis who presented with progressive right-sided limb weakness and dysarthria is reported. Brain magnetic resonance imaging revealed multiple ring-enhancing lesions accompanied by extensive perilesional edema. Due to the severity of the symptoms and a notable mass effect, surgical intervention was performed to remove the gummatous lesion, followed by histopathological confirmation of syphilitic granuloma. The patient was subsequently treated with high-dose intravenous penicillin, which led to notable improvement in neurological function and resolution of the symptoms; follow-up imaging demonstrated no recurrence of intracranial lesions. In conclusion, the present case illustrates the importance of early recognition and a multidisciplinary approach in the management of neurosyphilis with cerebral gummata. Increased awareness of this rare presentation may facilitate a timely diagnosis and appropriate treatment in similar clinical scenarios.