Huang Yin-Hui, Shi Qing-Xiao, Xu Mian-Mian, Chen Chuan-Zhen, Yang Mei-Li, Li Jun-Jing, Chen Ya-Fang, Lin Zhi-Qiang, Lin You-Yu
Department of Neurology, Jinjiang Municipal Hospital, Jinjiang.
Department of Neurology, Second Affiliated Hospital of Fujian Medical University, Quanzhou
Ann Clin Lab Sci. 2019 Mar;49(2):265-270.
Spinal neurosyphilis manifesting as a solitary syphilitic gumma is exceedingly rare. There are non-specific imaging findings and challenges in the diagnosis of spinal syphilitic gumma, which could be easily misdiagnosed as tumor lesions and require surgical resection or biopsy.
We report the case of a 45-year-old female patient who was diagnosed with Spinal syphilitic gumma. Our case is the first reported case of spinal cord syphilitic gumma with intradural-extramedullary and intramedullary involvement.
Spinal syphilitic gumma exhibits diverse clinical manifestations, lacks specific imaging features, accompanied by the patient's history deliberately concealed. Since clinicians do not have sufficient knowledge about such rare cases, misdiagnosis and missed diagnosis will be likely. When there is clinical suspicion for spinal syphilitic gumma, clinicians should pay close attention to relevant medical history, carry out a comprehensive physical examination and specific serological tests and cerebrospinal fluid (CSF) analysis. In summary, in cases with stable neurologic conditions, a trial administration of intravenous penicillin with follow-up imaging may be the optimal treatment option, and in cases with rapid progression or acute exacerbation, a surgical resection together with systemic antibiotic treatment for syphilis after surgery may be the best treatment strategy.
表现为孤立性梅毒瘤的脊髓神经梅毒极为罕见。脊髓梅毒瘤的诊断存在非特异性影像学表现及挑战，易被误诊为肿瘤性病变，且需要手术切除或活检。
我们报告一例45岁女性患者，被诊断为脊髓梅毒瘤。我们的病例是首例报道的同时累及硬脊膜外髓外和髓内的脊髓梅毒瘤病例。
脊髓梅毒瘤临床表现多样，缺乏特异性影像学特征，且患者病史常故意隐瞒。由于临床医生对这类罕见病例认识不足，很可能导致误诊和漏诊。当临床怀疑脊髓梅毒瘤时，临床医生应密切关注相关病史，进行全面体格检查及特异性血清学检测和脑脊液（CSF）分析。总之，对于神经功能稳定的病例，静脉注射青霉素试验性治疗并进行随访影像学检查可能是最佳治疗选择；对于病情快速进展或急性加重的病例，手术切除并在术后进行系统性梅毒抗生素治疗可能是最佳治疗策略。
