Syphilitic meningoencephalitis associated with vasculitis

A 28 year-old man, with no previous comorbidity, pre -sented left side weakness and verbal fluency reduction. A computed tomography (CT) (Figure 1) performed in an-other hospital revealed hipodensity in the basal ganglia. After 20 days the patient presented a generalized tonic-clonic seizure and became stuporous (Glasgow Coma Scale 11/15), with aphasia, anisocoria (right > left pupil) with mild light reaction (Argyll Robertson pupil), and tetraparesis (Medical Research Council Scale of Muscle Strength 2/5). Ten days later the patient was admitted at our service and a MRI revealed multiple areas of isch-emia (Figure 2) suggestive of central nervous system vasculitis. Laboratorial evaluation revealed positive se-rology to HIV-1, HIV-1 RNA/mL 201.777 copies, CD4 count 97/mm