Wenjing Zhang,1,2,* Dongmei Xu,1,2,* Kaiyu Qin,1,2 Canglin Song,1,2 Ran Miao,1,2 Xiaoyang Ma,1,2 Cheng Kou,1,2 Yuming Huang1,2 

1National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China; 2Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yuming Huang, Beijing Ditan Hospital, Capital Medical University, No. 8. Jingshun East Street, Chaoyang District, Beijing, 100015, People’s Republic of China, Email 1142027570@qq.com

Background and Objectives: Syphilitic gumma is rare and has atypical manifestations. Herein we report the clinical, imaging, and biological findings of a cross-sectional study of syphilis with gumma. Seven patients are described, offering promise in terms of early diagnosis and thereby enabling timely detection and treatment.
Methods: In this study, 397 neurosyphilis patients were consecutively from January 2021 to June 2024. We identified seven neurosyphilis patients with gumma. Their sociodemographic, clinical status, manifestations, neuroimaging, and laboratory manifestations were assessed.
Results: In the 397 neurosyphilis patients, seven had gumma — a frequency of 1.8%. Two of the seven (28.6%) were male. Their age ranged from 46 to 70 years, and the median symptom onset age was 56 years old. All patients experienced symptoms of unilateral limb weakness or numbness. Two patients displayed varying degrees of headache symptoms, three exhibited memory deterioration, and three manifested lightning pain. Enhanced MRI scans showed continuous nodule-like or partly high signal intensity of the brain or spine. The pathological sections of the intracranial syphilitic gumma displayed neuronal degeneration, proliferation of glial cells, and infiltration of lymphocytes. All serum samples showed decreased levels after therapy. The levels of WBCs and protein had reduced in all patients after therapy. All patients were followed up for 6 months to 1.5 years after therapy, and follow-up brain and enhanced spine MRI scans indicated part or complete remission after treatment.
Conclusion: In clinical practice, gumma should be considered for patients with intracranial lesions and positive serum syphilis antibodies. Timely and accurate diagnosis would enable patients with gumma to achieve a more favorable prognosis through active anti-syphilis treatment.

Keywords: neurosyphilis, gumma, enhanced MRI, cerebrospinal fluid