To explore the diagnosis and treatment of syphilitic gumma and its differentiation from tumors.

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.

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.

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.