Spinal cord syphilis associated with human immunodeficiency virus infection: a treatable myelopathy.
A 33-year-old woman, seropositive for human immunodeficiency virus type 1 (HIV-1), presented with progressive weakness and numbness of the lower extremities, gait difficulties, and urinary frequency. Physical examination revealed bilateral lower extremity weakness, a left-sided Babinski reflex, and a thoracic sensory level to pinprick at T8. Serum rapid plasma reagin was 1:64, and fluorescent treponemal antibody-absorption (FTA-ABS) was 4+. Examination of the cerebrospinal fluid showed a mononuclear pleocytosis and reactive FTA-ABS. The myelopathy responded promptly to high-dose intravenous aqueous penicillin. Syphilis needs to be considered in the differential diagnosis of any patient who develops a myelopathy in association with HIV-1 infection. Because of the diverse nature in which syphilis may affect the spinal cord, treatment with intravenous aqueous penicillin, 12 to 24 million units daily, for a minimum of 10 days, should be considered in any HIV-1-seropositive patient with a progressive, unexplained myelopathy and positive serologic studies for syphilis.
Berger
J R
JR
Department of Neurology, University of Miami School of Medicine, Florida 33151.
D000328:Adult; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D009494:Neurosyphilis / Q000150:complications / Q000188:drug therapy*; D010406:Penicillins / Q000627:therapeutic use*; D013118:Spinal Cord Diseases / Q000188:drug therapy*
D010406:Penicillins