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Departments of Neurology (Dr. Berger and L. Pall), Internal Medicine (Dr. Berger), Pathology (Dr. Hensley), and Radiology (Drs. Ihmedian and Post), University of Miami School of Medicine, Miami, FL; and Division of Infectious Diseases and International Health, Department of Medicine (Dr. Waskin), Duke University Medical Center, Durham, NC.
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 nonreponemal serologic tests for syphilis followed high-dose aqueous penicillin therapy in both patients. These patients illustrate that (1) cerebral mass lesions occuring 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.
Address correspondence and reprint requests to Dr. Joseph R. Berger, Department of Neurology, University of Miami School of Medicine, 1501 NW 9th Avenue, Miami, FL 33136.
Supported in part by a grant from the National Institute of Neurological Disorders and Stroke (NS PO1 25569).
Presented in part at the 3rd Neuroscience of HIV infection Conference, Padua, Italy, June 1991.
Received August 19, 1991. Accepted for publication in final form December 2, 1991.
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