The differential diagnosis for a contrast-enhancing right frontoparietal lobe lesion includes intracranial neoplasms and infection. However, a cerebral syphilitic gumma should be suspected in a patient with positive serum and cerebrospinal fluid treponemal testing. Cerebral syphilitic gummata are rare manifestations of tertiary neurosyphilis in which granulomatous lesions develop within the brain parenchyma or meninges. Clinicians should know that unlike other forms of neurosyphilis (e.g., tabes dorsalis or general paresis), gummatous disease carries a favorable prognosis with appropriate antibiotic therapy, which was the outcome for the patient in this case.
Comment
The differential diagnosis for a contrast-enhancing right frontoparietal lobe lesion includes intracranial neoplasms and infection. However, a cerebral syphilitic gumma should be suspected in a patient with positive serum and cerebrospinal fluid treponemal testing. Cerebral syphilitic gummata are rare manifestations of tertiary neurosyphilis in which granulomatous lesions develop within the brain parenchyma or meninges. Clinicians should know that unlike other forms of neurosyphilis (e.g., tabes dorsalis or general paresis), gummatous disease carries a favorable prognosis with appropriate antibiotic therapy, which was the outcome for the patient in this case.