四例首诊误诊为肿瘤的神经梅毒树胶样肿病例  

Report of four cases with syphilitic gumma first misdiagnosed as tumor

作　　者：张依 许东梅 Zhang Yi;Xu Dongmei(Department of Neurology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院神经内科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2022年第4期280-286,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的进一步探讨神经梅毒树胶样肿的诊治及与肿瘤的鉴别。方法回顾性分析4例于首都医科大学附属北京地坛医院2017年9月至2021年12月住院患者的临床资料,均首诊为肿瘤,后被诊断为神经梅毒树胶样肿,分析4例患者的诊疗过程并复习相关文献。结果4例患者中,女性3例,男性1例,起病时临床表现均不相同,分别为头痛、肢体无力、癫痫发作、肢体麻木疼痛,首诊均诊断为肿瘤性疾病,完善检查后均确诊为树胶肿型神经梅毒,其中2例为手术后确诊;4例患者均完善了脑脊液梅毒相关化验及头颅核磁检查。4例患者给予青霉素400万单位、1次/4 h静脉滴注,连续2周驱梅治疗后均好转出院。结论树胶肿型神经梅毒临床表现多样,临床上常被误诊为颅内肿瘤,接诊医师需仔细询问患者病史,完善头颅核磁及腰椎穿刺等检查,以进一步鉴别。Objective To explore the diagnosis and treatment of syphilitic gumma and its differentiation from tumors.Methods Clinical data of 4 hospitalized patients in Beijing Ditan Hospital,Capital Medical University from September 2017 to December 2021 who were first diagnosed as tumor and later diagnosed as syphilitic gumma were reviewed.The diagnosis and treatment process of the 4 patients were analyzed,while relevant literatures were analyzed,retrospectively.Results There were 3 female and 1 male among the 4 patients.The clinical manifestations were different at onset,including headache,limb weakness,epileptic seizure,limb numbness and pain.All 4 cases were first diagnosed as tumor,who were finally diagnosed as syphilitic gumma,two of them were confirmed after surgery,and all of them had perfected cerebrospinal fluid syphilis-related tests and head MRI.The 4 patients were treated with penicillin with 4 million units intravenously every 4 hours for two consecutive weeks,and they were all improved and discharged.Conclusions The clinical manifestations of syphilitic gumma were various,and often misdiagnosed as intracranial tumor.It is necessary to enquire the medical history carefully,improve the head nuclear magnetic examination and lumbar puncture examination,and further differentiation.

关 键 词：神经梅毒 梅毒性树胶样肿 肿瘤 鉴别诊断 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]