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A 33-year-old woman,seropositive for human immunodeficiency virus type 1 (HIV-1),presented with progressive weakness and numbness of the lower extremities,gait difficulties,and urinary frequency.Physical examination revealed bilateral lower extremity weakness,a left-sided Babinski reflex, and a thoracic sensory level to pinprick at T8.Serum rapid plasma reagin was 1:64,and fluorescent treponemal antibody-absorption(FTA-ABS)was 4+. Examination of the cerebrospinal fluid showed a mononuclear pleocytosis and reactive FTA-ABS.The myelopathy responded promptly to high-dose intravenous aqueous penicillin.Syphilis needs to be considered in the differential diagnosis of any patient who develops a myelopathy in association with HIV-1 infection.Because of the diverse nature in which syphilis may affect the spinal cord,treatment with intravenous aqueous penicillin,12 to 24 million units daily,for a minimum of 10 days,should be considered in any HIV-1-seropositive patient with a progressive, unexplained myelopathy and positive serologic studies for syphilis. |
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