Syphilis mimicking trigeminal schwannoma

Sífilis imitando schwannoma trigeminal

A 20-year-old woman presented with a two-month history of temporal headache and right trigeminal nerve palsy. An MRI showed enlargement and contrast enhancement of the right trigeminal nerve, suggestive of a schwannoma (Figure A). Cerebrospinal fluid analysis disclosed: 10 cells/mm³, protein 76mg/dl, glucose 50mg/dl and positive Venereal Disease Research Laboratory test (VDRL). Serum VDRL was 1/256 and the Treponema pallidum haemagglutination was positive. She was treated with IV crystalline penicillin G 2.400.000 U/day for 14 days with clinical and radiological improvement (Figure B).

Gummatous cranial nerve palsy is rarely reported¹,² as the sole manifestation of syphilis, but should be considered in the differential diagnosis of nerve tumors.

Figure
Axial T1-weighted brain MRI showing enlargement and contrast enhancement in the right trigeminal nerve (A) and resolution after treatment with crystalline penicillin G (B).

References

• ¹
  Seeley WW, Venna N. Neurosyphilis presenting with gummatous oculomotor nerve palsy. J Neurol Neurosurg Psychiatry. 2004;75(5):789. http://doi.org/10.1136/jnnp.2003.025932
  » http://doi.org/10.1136/jnnp.2003.025932
• ²
  Hess CW, Rosenfeld SS, Resor SR. Oculomotor nerve palsy as the presenting symptom of gummatous neurosyphilis and human immunodeficiency virus infection: clinical response to treatment. JAMA Neurol. 2013;70(12):1582-3. http://doi.org/10.1001/jamaneurol.2013.1485
  » http://doi.org/10.1001/jamaneurol.2013.1485

Publication Dates

• Publication in this collection
  Feb 2017

History

• Received
  12 July 2016
• Accepted
  13 Sept 2016