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Acute syphilitic meningitis in an HIV-infected patient

Alex Wagemakers1, Dagmar Hepp2, Joep Killestein2

  • 1Department of Medical Microbiology and Infection Prevention, VU medical center, Amsterdam, The Netherlands.

Idcases
|August 14, 2018
PubMed

Insights

This case study highlights acute syphilitic meningitis in an HIV-infected patient presenting with seizures. Diagnosis was confirmed via brain biopsy, leading to successful treatment with benzylpenicillin.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Neurology

Background:

  • Syphilis can cause serious neurological complications, including meningitis.
  • HIV infection may alter the presentation and progression of neurosyphilis.
  • Acute syphilitic meningitis is a rare but critical diagnosis in immunocompromised individuals.

Purpose of the Study:

  • To report a case of acute syphilitic meningitis in an HIV-infected patient.
  • To illustrate diagnostic challenges and successful treatment strategies.
  • To emphasize the importance of considering syphilis in neurological presentations in HIV-positive individuals.

Main Methods:

  • Clinical presentation of a 28-year-old HIV-infected male with seizure.
  • Magnetic Resonance Imaging (MRI) findings of meningeal and cortical lesions.
  • Diagnostic confirmation using Polymerase Chain Reaction (PCR) and spirochete staining on brain biopsy.

Main Results:

  • MRI revealed characteristic meningeal and cortical involvement.
  • PCR and spirochete staining confirmed Treponema pallidum.
  • The patient showed a positive response to benzylpenicillin treatment.

Conclusions:

  • Acute syphilitic meningitis should be considered in HIV-infected patients with neurological symptoms.
  • Multimodal diagnostic approaches, including advanced imaging and biopsy, are crucial.
  • Prompt treatment with benzylpenicillin is effective for syphilitic meningitis.
Keywords:
MSM, men who have sex with menMeningitisSyphilisTreponema pallidum

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