EACS2023: 1084 Syphilitic gumma as cause of cerebral and hepatic lesions, a case series A. Killer , L. Haberl , C. De Angelis , H.-M. Orth , T. Lüdde , B.-E.O. Jensen University Hospital Düsseldorf, Gastroenterology, Hepatology, Infectious Diseases, Düsseldorf, Germany Title Clinical case title: Syphilitic gumma as cause of cerebral and hepatic lesions, a case series Clinical case body Text: Background: Lues is a sexually transmitted disease with increasing incidence and therefore need for awareness. Due to the different manifestations at different stages, lues can cause a plethora of symptoms and affect different organs. 46% of lues cases in Germany occur in MSM living with HIV. Case report: We report two different cases of syphilitic-gumma. The first case was a 31-year-old man presenting to the emergency-department with a seizure, after which an MRI-scan revealed a 1.8 cm cerebral lesion and leukoencephalopathy. A positive HIV test followed. We suspected lymphoma, so a biopsy followed. The histology showed granulomas without evidence of lymphoma. CD4 count was 248/µl, TPPA 1:40960, cardiolipin 1:8 CSF, CSF titer 1:4096, and ART with BIC/FTC/TAF was initiated. After penicillin G i.v. treatment (30M/d) for 3 weeks, MRI follow-up showed shrinkage of the cerebral lesion and improvement of leukencephalopathy. On outpatient examination several months later, there was no evidence of physical sequelae. The second case was a 43-year-old man with treated HIV infection. Due to recurrent pain, he presented to his HIV physician, who performed a CT scan, which revealed hepatic lesions leading to hospitalization. On sonography, the lesions were echo-deficient and max 2.5cm. We suspected lymphoma and performed a liverbiopsy. Histology was able to rule out lymphoma or TB, but showed giant-cell-granulomatosis. The patient had a diagnosed lues, that had already been treated with benzathine-benzylpenicillin for 3 courses. Serology revealed a cardiolipin test of 1:256, so persistent lues infection was suspected. Because of a reported allergic reaction to benzathine-benzylpenicillin, we initiated ceftriaxone treatment for 10 days. Sonographic controls demonstrated a positive treatment outcome with regressive and eventually undetectable hepatic-lesions. Conclusion: Lues-gumma is an important differential-diagnosis for tumors in PLWH. Diagnosis was difficult in both cases because of nonspecific histology, but treatment resulted in complete remission in both cases. 1 1 1 1 1 1 1 857
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