Abstract Details

Title A Case of Neuropsyphilis Presenting as Multiple Ring Enhancing Lesions Mimicking Cerebral Abscesses

Topic Infections/AIDS/Prion Disease

Presentation(s) P04 - (-)

Poster/Presentation
Number 015

Objective

Background BACKGROUND: One of the rare clinical presentations of tertiary syphilis is cerebral syphilitic gummata. There are only few case reports that have described imaging findings to date. Here we present a case seen at University at Buffalo to better characterize imaging findings in cerebral gummata.

Design/Methods DESIGN/METHODS: Case report/ Clinical, radiologic, and pathologic correlation.

Results RESULTS: An 84 -year old male was admitted to our institution with pneumonia and showed clinical improvement after treatment with Ceftriaxone. After two days he had a generalized tonic-clonic seizure and later developed dysarthria, left facial droop and left arm weakness. No recurrence of fever or headache was reported. Brain MRI revealed multiple ring enhancing lesions with restricted diffusion, ventriculitis and meningeal gumma like lesions. Serology was positive for TP-PA, however, negative for RPR titres. CSF studies showed high white cell count (> 50) and elevated proteins. Brain biopsy demonstrated vasculocentric granulomatous inflammation that confirmed diagnosis of syphilis. Patient was treated with Ceftriaxone followed by Penicillin G and showed significant clinico- imaging improvement.

Conclusions CONCLUSIONS: Cerebral syphilitic gummata can have nebulous neuroimaging features, and a diagnosis of Neurosyphilis should be suspected when the MRI of the brain shows multiple lesions not limited to specific arterial territories and T2 hyperintensities that are not consistent with a diagnosis of any demyelinating or neoplastic disease. Brain biopsy can be useful to exclude cerebral abscess or tuberculoma or tumors. Better knowledge of these potential manifestations of neurosyphilis may facilitate more prompt diagnosis and treatment.

Authors/Disclosures
Rajesh K. Gupta, MBBS (UTHealth) PRESENTER	Dr. Gupta has nothing to disclose.
	No disclosure on file
	No disclosure on file
M. Reza Samie, MD, FACP, FAAN (Buffalo VA WNY Health System Medical Service)	No disclosure on file

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