Skip Navigation LinksHome > September 2013 - Volume 346 - Issue 3 > Widening the Differential for Brain Masses in Human Immunode...
American Journal of the Medical Sciences:
doi: 10.1097/MAJ.0b013e31828c9f22
Case Report

Widening the Differential for Brain Masses in Human Immunodeficiency Virus-Positive Patients: Syphilitic Cerebral Gummata

Land, Andrew M. MD; Nelson, George A. MD; Bell, Stephen G. MD; Denby, Kara J. BS; Estrada, Carlos A. MD, MS; Willett, Lisa L. MD

Collapse Box


Abstract: A 39-year-old man with newly diagnosed human immunodeficiency virus (HIV) infection was admitted with right-sided weakness, right-sided vision loss and slurred speech, which worsened over several weeks. Brain imaging revealed bilateral intraparenchymal ring-enhancing lesions and enhancement of the right optic nerve. Serological findings were positive for venereal disease research laboratory test, whereas the cerebrospinal fluid venereal disease research laboratory test was nonreactive. Brain biopsy suggested a diagnosis of syphilitic cerebral gummata, and the patient’s improvement with penicillin and dexamethasone further supported this etiology. Syphilitic cerebral gummata have rarely been reported in patients with HIV infection. This patient demonstrates that cerebral gummata should be considered in the differential diagnosis in immunocompromised patients with characteristic brain masses, that HIV and syphilis often coexist with early neurosyphilis appearing more frequently in this patient population and that normal cerebrospinal fluid studies may not represent a true lack of syphilitic activity in HIV patients.

Copyright © 2013 by the Southern Society for Clinical Investigation.


Article Tools


Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.