J Korean Soc Radiol.  2013 Sep;69(3):181-185. 10.3348/jksr.2013.69.3.181.

Cerebral Gumma Mimicking a Brain Tumor in a Human Immunodeficiency Virus-Negative Patient: A Case Report

• Baek HJ
• Kim WJ

• KMID: 2208798
• DOI: http://doi.org/10.3348/jksr.2013.69.3.181

Abstract

Syphilis has a broad spectrum of clinical manifestations, and the cerebral gumma is a kind of neurosyphilis which is rare and can be cured by appropriate antibiotic treatments. However, in clinical practices, diagnosis of cerebral syphilitic gumma is often difficult because imaging and laboratory findings revealed elusive results. Herein, we present a rare case of neurosyphilis presenting as cerebral gumma confirmed by histopathological examination, and positive serologic and cerebrospinal fluid analyses. This case report suggests that cerebral gumma should be considered as possible diagnosis for human immunodeficiency virus-negative patients with space-occupying lesion of the brain. And this case also provides importance of clinical suspicions in diagnosing neurosyphilis because syphilis serology is not routinely tested on patients with neurologic symptoms.

MeSH Terms

Brain
Brain Neoplasms
Humans
Magnetic Resonance Imaging
Neurologic Manifestations
Neurosyphilis
Syphilis

Figure

• 

  Fig. 1 A 55-year-old woman with headache and dysarthria for 3 months. A. CT scan reveals an isodense mass-like lesion with central hypodensity in the left frontal lobe with perilesional edema. B. T1-weighted image shows a round mass-like lesion with central hypointensity and peripheral isointensity in the left frontal operculum. C. T2-weighted image shows layered signal intensities with internal inhomogeneity and perilesional edema. A peripheral portion of the lesion reveals mostly isointensity whereas central portion shows mixed signal intensities. D, E. Contrast enhanced T1-weighted images demonstrate peripheral ring-like enhancement of the lesion with focal nonenhancing area in the central portion. Small sized enhancing nodular lesions are also seen in both medial temporal areas and perimesencephalic cistern (arrows). F, G. DWI (F) shows central hypointensity with subtle hyperintensity along peripheral portion of the lesion. ADC map (G) demonstrates no definite diffusion restriction. H. A single voxol, short TE MRS shows increased lipid and lactate peaks around 1.3 ppm without definite change of choline peak. Note.-ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, MRS = MR spectroscopy, TE = echo time

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  Fig. 2 Follow-up MR images of the patients. Seven months after surgery, the preexisting brain lesions were completely disappeared without newly developed brain lesions.

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