Meningovascular Syphilis Mimicking an Acute Cerebrovascular Evento in A Young HIV-Positive Patient

Abstract

Syphilis is a common infectious disease in people living with HIV and can affect the central nervous system (CNS) at any stage of infection, manifesting with various neurological abnormalities. We present the case of a young patient admitted with dysarthria, facial asymmetry, and hemiparesis of sudden onset. The initial brain CT scan was normal, but a follow-up scan reveled left thalamocapsular hypodensity. Serology showed a reactive RPR (1:128) and an indeterminate rapid HIV test. Lumbar puncture revealed hypoglycorrhachia and hyperproteinorrhachia with lymphocytic pleocytosis and a positive VDRL (1:128 dilutions). Meningovascular syphilis was diagnosed, treated with intravenous penicillin G and antiretroviral therapy, with a favorable outcome.