获得性梅毒性颅骨炎合并梅毒性脑膜炎

Acquired syphilitic skull osteitis accompanied by syphilitic meningitis： a case report

报告国内首例获得性梅毒性颅骨炎合并梅毒性脑膜炎。患者女，55岁，2个月前无诱因于头顶部和枕部出现持续性胀痛。磁共振成像T1加权像提示：颅骨多发性病变，邻近脑膜线状强化。查血快速血浆反应素环状卡片试验（RPR）1 ∶ 32阳性，梅毒螺旋体明胶凝集试验（TPPA）阳性；脑脊液检查：白细胞10 × 10^6/L，蛋白0.82 g/L，RPR 1 ∶ 4阳性，TPPA阳性；额骨骨膜梅毒螺旋体DNA阳性。组织病理示：颅骨灶性溶骨性破坏，骨纹理模糊，碎骨组织周围和硬膜样组织充血，间质纤维组织增生，内皮细胞肿胀，大量浆细胞为主炎细胞浸润。治疗：按神经梅毒的治疗方案治疗，头痛于治疗3 d后缓解，15 d后基本消失，30 d后完全消失，之后未再出现类似的头痛。随访5年，近期疗效和远期疗效均满意。最终诊断：梅毒性颅骨炎合并梅毒性脑膜炎。

The first case of acquired syphilitic skull osteitis accompanied by syphilitic meningitis in China is reported. A 55-year-old female presented with a persistent distending pain of the frontal and occipital regions of the skull for two months. T1 weighted magnetic resonance imaging （MRI） showed multiple lesions in the skull and linear enhancement of the meninge near the lesions. The serum and cerebrospinal fluid （CSF） were positive for Treponema pallidum particle agglutination assay （TPPA） and rapid plasma reagin circle card test （at the dilutions of 1 ∶ 32 and 1 ∶ 4 respectively）. The levels of leukocyte and protein were 10 × 106/L and 0.82 g/L respectively in CSF. TP DNA was detected in the calvarial periosteum. Histopathological examination of the frontal bone showed focally destructive osteolytic lesions with obscure texture of the bone, hyperemia around the destructive bone tissue and in dura mater-like tissues, proliferation of interstitial fibrous tissue, swelling of endothelial cells and inflammatory infiltration predominantly composed of abundant plasma cells. After managed with routine treatment regimen for neurosyphilis, her headache was relieved 3 days later, nearly disappeared 15 days later, completely disappeared 30 days later. No similar headache recurred. A 5-year follow up demonstrated a satisfactory long-term and short-term outcome. She was finally diagnosed with syphilitic skull osteitis complicated by syphilitic meningitis.