BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdia...BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.展开更多
BACKGROUND Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported. ...BACKGROUND Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported. Only a few cases of syphilitic myelitis have been documented. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis. However, the clinical features of syphilitic myelitis with longitudinally extensive myelopathy have been still not clear. AIM To explore the clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging (MRI). METHODS First, we report a patient who suffered from syphilitic myelitis with symptoms of sensory disturbance, with longitudinally extensive myelopathy with "flip-flop sign" on spinal MRI. Second, we performed a literature search to identify other reports (reviews, case reports, or case series) from January 1987 to December 2018, using the PubMed and Web of Science databases with the terms including "syphilis","neurosyphilis","syphilitic myelitis","meningomyelitis","central nervous system", and "spine". We also summarized the clinical features of syphilitic myelitis with longitudinally extensive myelopathy. RESULTS A total of 16 articles of 20 cases were identified. Sixteen patients presented with the onset of sensory disturbance (80%), 15 with paraparesis (75%), and 9 with urinary retention (45%). Eleven patients had a high risk behavior (55%). Five patients had concomitant human immunodeficiency virus infection (25%).Serological data showed that 15 patients had positive venereal disease research laboratory test (VDRL)/treponema pallidum particle agglutination (TPHA), and 17 had positive VDRL/TPHA in cerebrospinal fluid (CSF). Seventeen patients were found to have elevated leukocytosis and protein in CSF. On MRI, 16 patients showed abnormal hyperintensities involved the thoracic spine, 6 involved the cervical spine, and 3 involved both the cervical and thoracic spine. There were 3 patients with the "flip-flop sign". All the patients were treated with penicillin, and 15 patients had a good prognosis. CONCLUSION Our case further raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries such as China.展开更多
BACKGROUND Retrocorneal hyaline scrolls are a rare phenomenon.We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis.CASE SUMMARY A 71-year-old woman pr...BACKGROUND Retrocorneal hyaline scrolls are a rare phenomenon.We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis.CASE SUMMARY A 71-year-old woman presented with blurred vision due to cataracts.Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea.The patient was positive for syphilis-specific antibodies,with no ocular or systemic evidence of congenital or acquired syphilis.Binocular cataract,retrocorneal scroll,and corneal endothelial gutta were considered.The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin–eosin staining and scanning electron microscopy.The cornea of the right eye remained transparent,and the residual scroll seemed stable,however,the corneal endothelial density declined at 13 mo after surgery.In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium,with enlarged endothelial cells in both eyes.Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet’s membrane were observed.The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure.CONCLUSION Occult congenital syphilis could induce corneal endothelial gutta and theformation of retrocorneal scrolls without other signs of ocular syphilis.展开更多
Objective: To study the occurrence and development ofprimary syphilis from a morphological and structural aspect.Method: The ultrastructural pathological changes of syphiliticchancre were examined by transmission elec...Objective: To study the occurrence and development ofprimary syphilis from a morphological and structural aspect.Method: The ultrastructural pathological changes of syphiliticchancre were examined by transmission electron microscopy(TEM). Results: The pathological changes of syphilitic chancreoccur mainly in the dermal layer, manifested as partialthinning or lysis of the capillary basal membrane,proliferation of capillary endothelial cells, thickening of somecollagen fibers and rupture of collagen fibers surrounding Tpallidum, structural disruption of the axons of terminal nerves,disarrangement of the sheath of the myelinated nerve fiberswith separation of laminae and the attachment of T pallidumon its outer membrane, appearance of slightly swollen Tpallidum in the plasma of the capillary endothelial cells andfibroblasts, and infiltration of neutrophils, macrophages andplasma cells containing T pallidum and its debris frequentlylined by a clear sheath. Conclusion: The pathogenesis and injury of mechanism inprimary syphilis can be explained morphologically by itscharacteristic ultrastructural pathological changes.展开更多
The liver is an organ that withstands a lot of insults due to various things such as infection, toxins and even our own immune system. There are injuries to the liver that are relatively common in medicine such as vir...The liver is an organ that withstands a lot of insults due to various things such as infection, toxins and even our own immune system. There are injuries to the liver that are relatively common in medicine such as viral hepatitis caused by different strains of Hepatitis A-E, autoimmune hepatitis, and injury by drugs such as acetaminophen. However, syphilis causing hepatitis is not seen often and there are certain features that distinguish syphilitic hepatitis that should be reported more to distinguish its characteristic features.展开更多
Syphilitic alopecia (SA) is a rare skin manifestation in secondary syphilis and sometimes indistinguishable from other alopecia. SA is of 2 types, symptomatic and essential, and 3 clinical types, moth-eaten or patchy ...Syphilitic alopecia (SA) is a rare skin manifestation in secondary syphilis and sometimes indistinguishable from other alopecia. SA is of 2 types, symptomatic and essential, and 3 clinical types, moth-eaten or patchy pattern, diffuse pattern and a combination of both. SA in our case indicated symptomatic SA with moth-eaten hairloss. A 46-year-old Japanese homosexual man experienced hairloss followed by the pruritic skin rash. Physical examination of the scalp showed diffusely spread papulosquamous erythema and incomplete hairloss around the lesions. The scalp lesions appeared as “moth-eaten alopecia”. Serological examination for syphilis and HIV were positive. Thus, SA complicated with HIV infection was diagnosed. He was treated with a single perioral dose of ampicillin for 4 weeks, then his condition improved rapidly and hair regrowth occurred. HIV-infected persons show a high incidence of syphilis. Therefore, HIV test should be considered for patients with alopecia.展开更多
文摘BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.
基金Supported by the National Natural Science Foundation of China,No.81301016the Beijing Municipal Administration of Hospitals Incubating Program,No.PX2019009
文摘BACKGROUND Syphilitic myelitis caused by Treponema pallidum is an extremely rare disease. However, symptomatic neurosyphilis, especially syphilitic myelitis, and its clinical features have been infrequently reported. Only a few cases of syphilitic myelitis have been documented. To the best of our knowledge, there are only 19 reported cases of syphilitic myelitis. However, the clinical features of syphilitic myelitis with longitudinally extensive myelopathy have been still not clear. AIM To explore the clinical features of syphilitic myelitis with longitudinally extensive myelopathy on spinal magnetic resonance imaging (MRI). METHODS First, we report a patient who suffered from syphilitic myelitis with symptoms of sensory disturbance, with longitudinally extensive myelopathy with "flip-flop sign" on spinal MRI. Second, we performed a literature search to identify other reports (reviews, case reports, or case series) from January 1987 to December 2018, using the PubMed and Web of Science databases with the terms including "syphilis","neurosyphilis","syphilitic myelitis","meningomyelitis","central nervous system", and "spine". We also summarized the clinical features of syphilitic myelitis with longitudinally extensive myelopathy. RESULTS A total of 16 articles of 20 cases were identified. Sixteen patients presented with the onset of sensory disturbance (80%), 15 with paraparesis (75%), and 9 with urinary retention (45%). Eleven patients had a high risk behavior (55%). Five patients had concomitant human immunodeficiency virus infection (25%).Serological data showed that 15 patients had positive venereal disease research laboratory test (VDRL)/treponema pallidum particle agglutination (TPHA), and 17 had positive VDRL/TPHA in cerebrospinal fluid (CSF). Seventeen patients were found to have elevated leukocytosis and protein in CSF. On MRI, 16 patients showed abnormal hyperintensities involved the thoracic spine, 6 involved the cervical spine, and 3 involved both the cervical and thoracic spine. There were 3 patients with the "flip-flop sign". All the patients were treated with penicillin, and 15 patients had a good prognosis. CONCLUSION Our case further raises awareness of syphilitic myelitis as an important complication of neurosyphilis due to homosexuality, especially in developing countries such as China.
基金Zhejiang Provincial Medical and Health Technology Project,No.2020KY215.
文摘BACKGROUND Retrocorneal hyaline scrolls are a rare phenomenon.We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis.CASE SUMMARY A 71-year-old woman presented with blurred vision due to cataracts.Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea.The patient was positive for syphilis-specific antibodies,with no ocular or systemic evidence of congenital or acquired syphilis.Binocular cataract,retrocorneal scroll,and corneal endothelial gutta were considered.The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin–eosin staining and scanning electron microscopy.The cornea of the right eye remained transparent,and the residual scroll seemed stable,however,the corneal endothelial density declined at 13 mo after surgery.In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium,with enlarged endothelial cells in both eyes.Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet’s membrane were observed.The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure.CONCLUSION Occult congenital syphilis could induce corneal endothelial gutta and theformation of retrocorneal scrolls without other signs of ocular syphilis.
文摘Objective: To study the occurrence and development ofprimary syphilis from a morphological and structural aspect.Method: The ultrastructural pathological changes of syphiliticchancre were examined by transmission electron microscopy(TEM). Results: The pathological changes of syphilitic chancreoccur mainly in the dermal layer, manifested as partialthinning or lysis of the capillary basal membrane,proliferation of capillary endothelial cells, thickening of somecollagen fibers and rupture of collagen fibers surrounding Tpallidum, structural disruption of the axons of terminal nerves,disarrangement of the sheath of the myelinated nerve fiberswith separation of laminae and the attachment of T pallidumon its outer membrane, appearance of slightly swollen Tpallidum in the plasma of the capillary endothelial cells andfibroblasts, and infiltration of neutrophils, macrophages andplasma cells containing T pallidum and its debris frequentlylined by a clear sheath. Conclusion: The pathogenesis and injury of mechanism inprimary syphilis can be explained morphologically by itscharacteristic ultrastructural pathological changes.
文摘The liver is an organ that withstands a lot of insults due to various things such as infection, toxins and even our own immune system. There are injuries to the liver that are relatively common in medicine such as viral hepatitis caused by different strains of Hepatitis A-E, autoimmune hepatitis, and injury by drugs such as acetaminophen. However, syphilis causing hepatitis is not seen often and there are certain features that distinguish syphilitic hepatitis that should be reported more to distinguish its characteristic features.
文摘Syphilitic alopecia (SA) is a rare skin manifestation in secondary syphilis and sometimes indistinguishable from other alopecia. SA is of 2 types, symptomatic and essential, and 3 clinical types, moth-eaten or patchy pattern, diffuse pattern and a combination of both. SA in our case indicated symptomatic SA with moth-eaten hairloss. A 46-year-old Japanese homosexual man experienced hairloss followed by the pruritic skin rash. Physical examination of the scalp showed diffusely spread papulosquamous erythema and incomplete hairloss around the lesions. The scalp lesions appeared as “moth-eaten alopecia”. Serological examination for syphilis and HIV were positive. Thus, SA complicated with HIV infection was diagnosed. He was treated with a single perioral dose of ampicillin for 4 weeks, then his condition improved rapidly and hair regrowth occurred. HIV-infected persons show a high incidence of syphilis. Therefore, HIV test should be considered for patients with alopecia.
