Morgello S, Laufer H
Department of Pathology (Neuropathology), Queens Hospital Center, NY.
Hum Pathol. 1989 Aug;20(8):808-11. doi: 10.1016/0046-8177(89)90078-6.
A 22-year-old Haitian man had a 15-month course of progressive meningitis accompanied by multiple cerebral infarcts. Multiple areas of stenosis and occlusion in all branches of the circle of Willis, and hypertrophy of collateral perforating vessels at the base of the brain in a "puff of smoke" appearance typical of moyamoya disease were seen on cerebral angiogram 5 months before the patient died. At autopsy, the patient had meningovascular syphilis and a necrotizing encephalitis with massive treponemal invasion of the brain, the pathology of late-stage degenerative, "quaternary", neurosyphilis. The patient was also infected with human immunodeficiency virus (HIV). Retrovirus-like particles 100 nm in diameter with dense cores were seen by electron microscopy. Nucleic acid obtained from the patient's brain contained sequences homologous to HIV DNA as determined by dot blot hybridization. The moyamoya-like radiologic appearance of neurosyphilis has not been previously described. The autopsy finding of quaternary neurosyphilis in a patient with HIV infection supports the hypothesis that retrovirus may alter the natural history of syphilitic infection.
一名22岁的海地男子患有长达15个月的进行性脑膜炎，并伴有多发性脑梗死。在患者死亡前5个月的脑血管造影中，可见Willis环所有分支的多处狭窄和闭塞，以及脑底部侧支穿支血管呈典型烟雾病表现的肥大。尸检时，患者患有脑膜血管梅毒和坏死性脑炎，大脑有大量梅毒螺旋体侵袭，这是晚期退行性“四期”神经梅毒的病理表现。该患者还感染了人类免疫缺陷病毒（HIV）。电子显微镜下可见直径100纳米、核心致密的逆转录病毒样颗粒。通过斑点印迹杂交测定，从患者大脑中获取的核酸含有与HIV DNA同源的序列。神经梅毒类似烟雾病的放射学表现此前尚未见报道。在一名HIV感染患者中发现四期神经梅毒的尸检结果支持了逆转录病毒可能改变梅毒感染自然病程这一假说。
