Syphilitic cerebral gumma with HIV infection.
We describe two human immunodeficiency virus (HIV)-infected patients with syphilitic cerebral gummas. Both patients presented with a seizure disorder associated with an isolated, peripherally located, contrast-enhancing lesion of the brain on CT. Cranial MRI performed on one patient revealed dural thickening in the region of the lesion. A brain biopsy in that patient revealed a lymphoplasmacytic infiltrate with extensive perivascular inflammation. Clinical manifestations, radiographic resolution of the lesions, and a decline in nontreponemal serologic tests for syphilis followed high-dose aqueous penicillin therapy in both patients. These patients illustrate that (1) cerebral mass lesions occurring with HIV infection may result from syphilis; (2) seizures may be the presenting manifestation of this form of neurosyphilis; and (3) high-dose, intravenous, aqueous penicillin is effective in treating these lesions.
Berger
J R
JR
Department of Neurology, University of Miami School of Medicine, FL 33136.
Waskin
H
H
Pall
L
L
Hensley
G
G
Ihmedian
I
I
Post
M J
MJ
D000328:Adult; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009494:Neurosyphilis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed