Gummatous

Gummatous refers to gumma-related lesions that occur in tertiary syphilis, a late manifestation of infection with Treponema pallidum. Gummas are chronic, granulomatous lesions that can form in skin, mucous membranes, bone, liver, testes, and other organs. They develop months to years after initial infection and reflect a delayed cell-mediated immune response; spirochetes are typically sparse or absent in established gummatous lesions.

Pathology and presentation: Histology shows granulomatous inflammation with macrophages and epithelioid cells, giant cells, plasma cells, and fibrosis, surrounding a central area of necrosis. Clinically, gummas are firm nodules that may ulcerate and drain, eventually creating destructive ulcers and deformities, especially in exposed areas of the face and palate or within bones.

Diagnosis: Diagnosis relies on serology for syphilis (non-treponemal tests such as VDRL or RPR and treponemal tests such as FTA-ABS or TP-PA) and, when accessible, histopathology. Biopsy helps distinguish gummas from neoplasms or other granulomatous diseases.

Treatment and prognosis: Treatment consists of appropriate antibiotic therapy with penicillin G; standard regimens include benzathine penicillin G given weekly for three weeks for late syphilis. Alternatives exist for penicillin allergies. Lesions generally respond to therapy; residual scarring or deformity may persist. Prognosis is favorable with adequate treatment, though extensive gummatous destruction may require surgical repair. Gummatous syphilis remains rare in developed countries but can occur in untreated infections or in settings with limited access to care.