Acute syphilitic meningitis in a man with seropositivity for human immunodeficiency virus infection and normal numbers of CD4 T lymphocytes.
Coinfection with the human immunodeficiency virus (HIV) and Treponema pallidum may predispose to accelerated neurosyphilis. The mechanism underlying this interaction is undefined, but usually presumed to result from HIV-induced suppression of cell-mediated immunity as reflected in the CD4 T-lymphocyte count. We report a patient infected with HIV who developed aggressive neurosyphilis despite a CD4 count of 1000/mm3. The CD4 cells constituted 17% of his total lymphocytes. Our case suggests that while severe neurosyphilis can occur in HIV-infected persons with normal absolute CD4 counts, the percentage of CD4 cells may be a better indicator of the risk of neurosyphilis. These observations are relevant to designing treatment strategies for patients coinfected with HIV and T pallidum based on measures of their immunocompetence.
Division of Infectious Disease, Cooper Hospital/University Medical Center, UMDNJ/Robert Wood Johnson Medical School, Camden.
M J
MJ
DiNubile
J D
JD
Baxter
T R
TR
Mirsen
D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology; D006801:Humans; D007111:Immunity, Cellular; D007958:Leukocyte Count; D008297:Male; D008587:Meningitis, Viral / Q000150:complications*; D008875:Middle Aged; D013587:Syphilis / Q000150:complications*