Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Am J Med Sci. 2013 Sep;346(3):253-5. doi: 10.1097/MAJ.0b013e31828c9f22.
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.
一位 39 岁男性，新诊断为人免疫缺陷病毒（HIV）感染，因右侧无力、右侧视力丧失和言语不清入院，这些症状在数周内逐渐加重。脑部影像学显示双侧脑实质内环状增强病变和右侧视神经增强。血清学检查发现性病研究实验室试验阳性，而脑脊液性病研究实验室试验无反应。脑活检提示为梅毒性脑树胶肿，患者对青霉素和地塞米松的改善进一步支持了这一病因。HIV 感染者中很少有梅毒性脑树胶肿的报道。该患者表明，在免疫功能低下的患者中，具有特征性脑肿块时，应考虑脑树胶肿作为鉴别诊断，HIV 和梅毒通常同时存在，且早期神经梅毒在该患者人群中更为常见，脑脊液检查正常可能并不代表 HIV 患者中梅毒活动的真实缺失。
