Gumma of nose due to a long standing tertiary syphilitic Treponema pallidum infection lores. Goma sifilítica en la nariz. Clasificación y recursos externos. Goma sifilítica intra-raquídea causando compressão medular. Relato de um caso . Do you want to read the rest of this article? Request full-text. Request Full-text. Spanish, Goma sifilítica, goma sifilítico (trastorno), goma sifilítico, sifiloma, sifílide gomatosa nodular. Japanese, 梅毒性ゴム腫, ﾊﾞｲﾄﾞｸｾｲｺﾞﾑｼｭ. Czech, Syfilitické.
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The journal accepts articles in Spanish or in English on the field of hospital medicine. The journal publishes original articles, clinical cases, reviews articles, history notes, issues on medical education, short communications and editorials at the invitation of the Society.
All articles are double blind peer reviewed by at least 2 reviewers and finally classified as accepted or rejected by the Editorial Board. Syphilis is a systemic disease caused by the spirochaete Treponema pallidum that affects the central nervous system at any time and whose clinical presentation has undergone changes in recent decades, due to the emergence of the acquired immune deficiency virus. We present the case of a year-old immunocompetent woman with no significant changes in sexual behaviour, who only presented with headache and speech disturbances mixed aphasia.
MRI and CT scans initially showed left parietal injury, and later left temporal recurrence. The patient was treated for neurosyphilis for 5 weeks and showed improvement at her one-month follow-up appointment, before once again manifesting speech disturbances with sensory aphasia six months after treatment onset.
Another control MRI was performed, revealing a relapse of the tumour lesion in the left temporal region. Intravenous treatment was once again initiated with benzathine penicillin and new serological and imaging tests were conducted, revealing the absence of lesions.
Gummatous neurosyphilis is a rare condition, which explains why it tends to be erroneously diagnosed and treated. It is for this reason that we have presented our case study and literature review. Presenta solo cefalea y alteraciones del habla afasia mixta. Syphilis is one of the many types of sexually-transmitted diseases. It is a systemic infectious disease caused by a spirochaete, Treponema pallidum.
It can affect most organs. The most common form of transmission is through sexual relations, but in some cases vertical transmission occurs, from the mother to the foetus.
In America, an incidence of 2. It is a rare brain finding observed during tertiary syphilis that can sometimes simulate different neoplastic brain lesions, confusing diagnosis and treatment. In this article we present the case of a year-old patient and we provide a literature review. A year-old female patient with a history of controlled systemic arterial hypertension and poor diet, with no history of sexual risk behaviour. She attended our offices due to alterations in language, mixed aphasia and moderate holocranial headache, with no attenuating or exacerbating factors, no predominance at a certain time of day, and subsiding spontaneously.
She referred one episode of seizures without specifying the characteristics, but they were apparently tonic-clonic. Neurological examination revealed mixed aphasia subsiding with the administration of steroids. No visual alterations were found during dilated fundus examination, electronic visual field or confrontation examination, and the rest of the cranial nerves were normal.
Given the suspicion of tumour lesion, she was treated with steroids and experienced clinical improvement. FLAIR sequence showed perilesional oedema extending towards the left temporal lobe.
Diffusion-weighted imaging showed areas of necrosis and haemorrhage, simulating a lesion with a probable neoplastic process with malignant characteristics, compatible with high-grade astrocytoma, but spectroscopy showed high levels of lactate and lipids Fig.
According to protocol, the patient underwent stereotactically-guided total resection of the tumour lesion Fig. As it was located in an eloquent area, the patient remained conscious during the intraoperative period to ensure the integrity of her language function. The entire lesion was resected; it was whitish with defined borders and implanted in the dura mater, from where it was removed. There was considerable gliosis and vessels adjacent to the tumour lesion. An intraoperative histopathological study reported areas of necrosis and gliosis, abundant chronic and acute inflammatory infiltrate, and numerous plasma cells; no spirochaetes were observed directly.
Given the suspicion of neurosyphilis and the definitive study by anatomical pathology, a Warthin—Starry stain immunohistochemical analysis was performed and the result was positive, detecting spirochaetes Fig. The study protocol was completed with serum RPR: The rest of the laboratory tests liver profile, coagulation profile, glucose, urea, creatinine and urine test and serological tests HIV, Brucella, Salmonella and hepatitis B were normal.
She was started on antibiotic treatment with 2, units of IM benzathine penicillin for 5 weeks, low doses of steroids and management of nutritional support; she was discharged from the hospital 7 days after the surgical procedure.
At her one-month follow-up appointment, there were no language alterations and expectant management was maintained. After 6 months, the patient presented with a new language disturbance, articulating words but unable to follow orders.
The MRI revealed a new left temporal tumour lesion compatible with sensory aphasia Fig. There were no other abnormalities during examination. Serum RPR showed 16 dil; no control serum treponemal tests were conducted. There were no other blood biometry alterations. Due to new clinical evidence and imaging techniques confirming neurosyphilis relapse, management was restarted with 4 million units of penicillin G sodium IV every 4 h, which was prolonged for 4 weeks due to a notable reduction in the lesion found on the control MRI.
To prevent Jarisch—Herxheimer reaction, dexamethasone was administered every 8 h, initially at 4 mg and then at a reduced dose.
Syphilitic aortitis: diagnosis and treatment. Case report
When treatment was complete, the syphilis serological tests showed a decrease in titres RPR: Six months after the second treatment regimen, the patient presented no abnormalities, with fluid language and no evidence of relapsing tumour lesions. Spectroscopy sequence showing markedly increased levels of lactate and lipids and a mild increase in choline. Contrast-enhanced CT scan of the left side of the brain showing stereotactic frame and fiducials; contrast medium enhancement of left parietal region showing tumour lesion with considerable perilesional oedema.
Follow-up non-contrast CT scan of the right side of the brain showing total resection of the lesion with hypodense image denoting gliosis in left parietal lobe. Neurosyphilis is a central nervous system CNS condition caused by T. It includes cases with clinical manifestations symptomatic neurosyphilis and those cases in which no symptoms occur asymptomatic neurosyphilis.
It only presents in the tertiary phase tabes dorsalis and progressive general paralysis. The first descriptions of the disease date back to the end of the 15th century. Non-sexual, direct and indirect transmission are possible through primary or secondary lesions. Other less common routes of transmission are through transfusions, bites or cuts, and through transplacental route. Bacteriaemia may occur, which is often subclinical or has non-specific symptoms. The first stage ends after 6—12 weeks when Treponema spreads into the blood, causing lymphadenopathies and generalised exanthema.
This second stage resolves spontaneously after four weeks. Afterwards there is a latent period called latent syphilis.
This period is divided into two phases by the International Classification of Diseases: Clinically, there are diverse forms of clinical presentation, including tabes dorsalis, as well as other neurological diseases vascular or meningeal syphilis.
Neurosyphilis forms of presentation. It tends to disappear spontaneously, although CSF abnormalities persist. Meningeal neurosyphilis is the earliest, under 1 year, and is generally associated with skin lesions.
It can present with intracranial hypertension, due to hydrocephalus, or focal signs due to acute meningitis of the vertex paresis, paralysis, seizures, etc. Meningovascular neurosyphilis is the most common form of presentation, which may occur after up to 12 years of infection. It has a prodromal period lasting weeks or months, with headache, vertigo, personality changes and insomnia.
Then vascular symptoms occur, sifilitia to other cerebrovascular conditions, except that it affects patients under 50 years of age. The gpma most affected is the MCA middle cerebral artery.
Left temporal cerebral syphilitic gumma : Case report and literature review
In this condition, progressive general paralysis used to be the main reason for admission to psychiatric institutions, sifilituca this is now uncommon. It occurs 15—20 years after infection. It is insidious in nature that generally starts with non-specific psychiatric symptoms, irritability, difficulty concentrating, emotional alteration and delirious ideas.
The final phases include dementia, tremor, dysarthria, seizures, paresis and alteration in sphincter control. Tabes dorsalis is the most delayed form of presentation, sifilitifa 18—25 years after the first infection.
There are clinical manifestations of episodes of shooting pain in the lower limbs, abdominal pain, paraesthesia, hypoaesthesia and alterations in tendon reflexes.
Ataxia and sifilitiac incontinence may also occur. CNS gumma forms a granulomatous nodule. It may present at any stage generally stage III and appear in any part of the body. In the CNS, gummas form from the pia mater; macroscopically they are observed as soft, well-defined lesions of varying size.
4ºAua DIVISÃO CELULAR – MITOSE E MEIOSE (1).ppt
Microscopically, they appear as a non-specific, chronic inflammatory infiltrate composed of lymphocytes and plasma cells. The manifestations presented will depend on the size and location of the lesion medullary or brain. Ocular syphilis may also occur, manifesting gkma uveitis, keratitis or chorioretinitis. Argyll Robertson pupil or anisocoria often present. Luetic optic neuritis is associated with meningitis, and peripapillary atrophy occurs as a result. Syphilitic amyotrophy is a hypertrophic pachymeningitis that frequently presents in the cervical medulla.
It presents with extrinsic compression, radicular involvement, atrophy of the upper extremities, pyramidal syndrome and posterior cord involvement. The different forms of clinical presentation are listed in Table 1. They are divided into early forms, which include meningeal and vascular involvement, and late forms, which include brain parenchyma involvement progressive general paralysis and tabes dorsalis.
The time to onset of these clinical forms depends on the time of primary infection. The disease may present in many clinical forms, manifesting complexly, and the late presentations may occur earlier, or occur simultaneously.
These presentations are explained by increases in HIV human immunodeficiency virus patients and due to the inadequate use of antibiotics prophylactically and in treatment. Diagnosis is made according to clinical manifestations, accompanied by abnormal biochemical findings and CSF sifilitiva tests. CT scan and MRI are only useful in diagnosing cases of gumma or sifiliticz forms.
Glycorrhachia is normal, except in meningitis where it is decreased. The serological test that confirms the disease continues to be rabbit testicular inoculation, capable of detecting up to 10 Treponema per inoculate, but this is not carried out in daily practice.
The main diagnostic method continues to be antibody detection tests in blood and CSF. There are two types: In early syphilis, FTA is the first test to be positive; in secondary forms all the tests show strong positivity. This makes it the test of choice for the diagnosis of neurosyphilis, although due to its low sensitivity a negative result does not exclude the disease.