Neurosyphilis with simultaneous brain and spinal cord involvement mimicking intracranial tumors: a case report.
[BACKGROUND] Neurosyphilis is a heterogeneous manifestation of infection with diverse clinical and radiological presentations.
APA
Bai D, Wang Z (2026). Neurosyphilis with simultaneous brain and spinal cord involvement mimicking intracranial tumors: a case report.. BMC neurology, 26(1). https://doi.org/10.1186/s12883-026-04836-2
MLA
Bai D, et al.. "Neurosyphilis with simultaneous brain and spinal cord involvement mimicking intracranial tumors: a case report.." BMC neurology, vol. 26, no. 1, 2026.
PMID
41906088
Abstract
[BACKGROUND] Neurosyphilis is a heterogeneous manifestation of infection with diverse clinical and radiological presentations. Concurrent involvement of the brain and spinal cord is rare and may mimic intracranial neoplasms, leading to diagnostic uncertainty.
[CASE PRESENTATION] A 48-year-old woman presented with acute-onset limb numbness and diplopia. Brain and cervical spine magnetic resonance imaging (MRI) revealed multiple nodular and ring-enhancing lesions involving the brain parenchyma and cervical spinal cord, initially raising suspicion of lymphoma or metastatic tumors. Diffusion-weighted imaging (DWI) showed atypical hypointensity without diffusion restriction. Histopathological examination demonstrated perivascular inflammatory infiltration without evidence of malignancy. Serological testing confirmed a reactive serum rapid plasma reagin (RPR) titer with treponemal confirmation, and metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) detected deoxyribonucleic acid (DNA), supporting the diagnosis of neurosyphilis. HIV serology was negative. Due to a documented penicillin allergy (positive penicillin skin test), the patient received alternative antimicrobial therapy with fosfomycin (8 g/day intravenously) and minocycline (100 mg orally twice daily), resulting in marked clinical improvement and regression of lesions on follow-up imaging.
[CONCLUSION] This report describes a patient in whom neurosyphilis presented with concurrent brain and spinal cord lesions that radiologically resembled malignant central nervous system (CNS) tumors. Multifocal nodular and ring-enhancing lesions without diffusion restriction, combined with clinical improvement following antimicrobial therapy, were features observed in this case that contributed to the diagnostic re-evaluation. This case highlights the importance of including neurosyphilis in the differential diagnosis of tumor-like CNS lesions when imaging findings are atypical, while acknowledging that definitive diagnostic conclusions are limited by the single-case nature of this report.
[CASE PRESENTATION] A 48-year-old woman presented with acute-onset limb numbness and diplopia. Brain and cervical spine magnetic resonance imaging (MRI) revealed multiple nodular and ring-enhancing lesions involving the brain parenchyma and cervical spinal cord, initially raising suspicion of lymphoma or metastatic tumors. Diffusion-weighted imaging (DWI) showed atypical hypointensity without diffusion restriction. Histopathological examination demonstrated perivascular inflammatory infiltration without evidence of malignancy. Serological testing confirmed a reactive serum rapid plasma reagin (RPR) titer with treponemal confirmation, and metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) detected deoxyribonucleic acid (DNA), supporting the diagnosis of neurosyphilis. HIV serology was negative. Due to a documented penicillin allergy (positive penicillin skin test), the patient received alternative antimicrobial therapy with fosfomycin (8 g/day intravenously) and minocycline (100 mg orally twice daily), resulting in marked clinical improvement and regression of lesions on follow-up imaging.
[CONCLUSION] This report describes a patient in whom neurosyphilis presented with concurrent brain and spinal cord lesions that radiologically resembled malignant central nervous system (CNS) tumors. Multifocal nodular and ring-enhancing lesions without diffusion restriction, combined with clinical improvement following antimicrobial therapy, were features observed in this case that contributed to the diagnostic re-evaluation. This case highlights the importance of including neurosyphilis in the differential diagnosis of tumor-like CNS lesions when imaging findings are atypical, while acknowledging that definitive diagnostic conclusions are limited by the single-case nature of this report.