Chávez ML, Aguirre QD, Velázquez GG, Ortiz HC, Alvarado AF, Benítez BL, Ramos SF, Olvera RJE

Language: Spanish
References: 8
Page: 172-177
PDF size: 342.39 Kb.

ABSTRACT

Syphilis is caused by the Treponema pallidum, a Gram-negative spirochete. Its frequency was notably diminished due to the sensitivity of the organism to most antibiotics, but there has been an increase of the disease since the 1980’s due to the advent of AIDS. Neurosyphilis occurs in the tertiary period, in 10% the untreated patients. It is difficult to find the microorganisms in the tissues during that period and the serologic tests like VDRL are negative. Three cases of syphilitic gummas that occurred in men aged 62, 52 and 43 are reported, the first was an autopsy case and the second and third were neurosurgical specimens. No relevant clinical manifestations of the primary and secondary periods were recorded. The course of the disease ranged was from two months to one year and was manifested by seizures, focal signs and increased intracranial pressure. By imaging studies the diagnosis in all of them was of a neoplastic lesion. The locations of the masses were in the left parietal, right temporal and left frontal lobes respectively. Patient number one died of pulmonary complications following surgery and had a large necrotic lesion, clay colored, surrounded by a rim of neoformed vessels and edema. In all three cases the microscopic examination revealed necrosis similar to the coagulative type, macrophages, perivascular cuffing with plasma cells and lymphocytes, rod cells and gliosis. Levaditi stain was performed in case 1 and Warthin-Starry in the other two. With both techniques, a few spirochetes were seen. Neurosyphilis has several clinico pathologic forms of presentation: meningovascular, general paresis, tabes dorsalis, gummas, optochiasmatic aracnoiditis, cervical pachymeningitis or it may be asymptomatic. The clinical diagnosis is not often made, but can be reached by specific tests, like FTA-Abs and TPHA that remain positive even after treatment. The possibility of the existence of a gumma should be kept in mind, since the medical and surgical treatments are usually beneficial.

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