Cerebral Syphilitic Gumma Confirmed by the Polymerase Chain Reaction in a Man with Human Immunodeficiency Virus Infection

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Abstract
Space-occupying lesions in the brain of patients infected with the human immunodeficiency virus (HIV) are commonly due to Toxoplasma gondii infection or lymphoma1. Multiple other infectious agents, including nocardia species and Mycobacterium tuberculosis, as well as bacterial abscesses also cause such lesions1. Despite the increased incidence of neurosyphilis in the HIV-infected population,2 with reports of both meningovascular and quaternary neurosyphilis,2-4 we are aware of only two instances of space-occupying lesions of the central nervous system presumed to be due to Treponema pallidum5 among the hundreds of biopsy and autopsy evaluations of brain tissue from patients with the acquired immunodeficiency syndrome (AIDS). We describe an HIV-infected patient in whom T. pallidum was identified in a brain gumma on the basis of morphologic findings and DNA amplification with the polymerase chain reaction (PCR).