How is gumma treated in neurosyphilis?

Updated: Jul 17, 2018
  • Author: Richard P Knudsen, MD, FAAN, FAAP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Corticosteroids (along with intravenous PCN) have been used in the clinical setting of cerebral gummata. [87] Massive doses (ie, dexamethasone at 12 mg/d intramuscularly for 1 mo, followed by methylprednisolone at 16 mg/d) have been prescribed. On occasion, neurosurgical decompression of coexistent hydrocephalus may be indicated. With treatment, the space-occupying lesions undergo complete resolution on neuroimaging studies and the clinical picture improves. If seizures are present, treat accordingly.

Syphilitic optic neuropathy (SON) (including iridocyclitis and posterior placoid chorioretinitis) has been recently reported to present as the sole and initial clinical manifestation of HIV and syphilis co-infection. [88, 89] This should be considered upon presentation of bilateral uveitis of uncertain origin, especially if the patient has a rash and/or headache. Adjunctive steroid therapy is touted to be advantageous toward improvement in optic nerve functional outcomes with SON. More rigorous studies are required for validation of this pharmacologic approach. [90] Ocular symptoms in HIV+ patients should be treated as neurosyphilis whereas ocular symptoms in non-HIV+ patients can be treated as secondary syphilis. [91]


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