Unsuspected central nervous system gummas in a case of "cerebral infarct" associated with cocaine use.
A 54-year-old African-American male was hospitalized with a left "cerebrovascular accident," altered mental status, agitation, rhabdomyolysis, and hypernatremia. Laboratory tests found cocaine in his system and a positive RPR (rapid plasmin reagin test). A CAT (computed axial tomography) scan without contrast taken 8 days prior to his death showed a left middle cerebral artery infarct, with edema and mass effect, and a 1-cm midline shift to the right. He underwent symptomatic treatment, eventually suffered cardiopulmonary arrest and multiorgan failure, and expired 8 days after admission. The left cerebral lesion diagnosed clinically as a cerebral infarct was actually determined to be a syphilitic gumma on postmortem neuropathologic examination. Neurosyphilis, although rare, should be considered in the differential diagnosis of space-occupying lesions in the brain because cases of syphilis continue to occur both sporadically and as an opportunistic infection associated with acquired immunodeficiency syndrome (AIDS) and because neurosyphilis is treatable.
Gyori
Eva
E
Miami-Dade County Medical Examiner Department, Miami, Florida 33136, USA. jvb@miamidade.gov
Lew
Emma O
EO
D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis*; D019970:Cocaine-Related Disorders / Q000150:complications*; D049429:Forensic Pathology; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D006955:Hypernatremia / Q000209:etiology; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000175:diagnosis*; D011595:Psychomotor Agitation / Q000209:etiology; D012206:Rhabdomyolysis / Q000209:etiology