SECONDARY SYPHILIS WITH NEUROLOGICAL SYMPTOMS IN AN HIV-POSITIVE PATIENT ALLERGIC TO PENICILLIN

A 41-year-old homosexual Caucasian man, who had been HIV (human immunodeficiency virus) positive for 2 years presented an active secondary syphilis beginning with neurological symptoms and abnormal liver tests. He developed severe allergic symptoms upon initiation of intra-venous penicillin therapy. Treatment was temporarily interrupted and he was given hydrocortisone and antihistamines. Alternative antibiotherapy to penicillin and desensitization tolerance induction were discussed. Seventy-two hours after onset of allergic manifestations, penicillin desensitization was performed (subcutaneous followed by intravenous injections of increasing low doses), followed by classical intravenous penicillin therapy (20 millions U/day) for 14 days. Neurological symptoms disappeared after 3 days, and biological tests normalized in 3 weeks. Serological parameters: VDRL (venereal disease research laboratory slide), FTA (fluorescent treponemal antibody absorption), MHA-TP (micro-hemaglutination assay for antibodies to Treponema pallidum), started to diminish after 2 months and all were negative a year later.