Background: Neurosyphilis is a common but often missed disease
worldwide, mainly because it has many manifestations making its
diagnosis difficult. It is often missed among HIV patients as the
search for other co-infections such as toxoplasmosis often overshadows
its consideration. Objectives: To describe one of our cases of
neurosyphilis in HIV, raise awareness about the reality of
neurosyphilis in Africa and share our experiences in diagnosis and
management of the disease. Methods: A 40 year old, HIV positive female
was admitted with a 2 month history of left sided facial and limb
weakness followed by delirium, aphasia and Jacksonian epilepsy. She
underwent clinical and laboratory evaluation. Results: On examination
she had a maculo-papular rash and left sided paresis. Rapid Plasma
Reagin(RPR) was reactive(titre 1:16). Treponema Pallidum
Haemoaggluttination Assay(TPHA) was also reactive. Cerebrospinal fluid
(CSF) analysis revealed: protein 56 mg per dl, glucose 71 mg per dl,
cells 14 per high power field (predominantly lymphocytes).The VDRL on
the CSF was positive. The CD4 cell count was 320 per ml. She was
treated with intravenous penicillin G, 4 mega-units 6 hourly for 14
days, with a very good response. Conclusion: Neurosyphilis still occurs
in Uganda. It should be considered in all patients with
neurological/ophthalmic illness, including those with HIV. Most cases
respond well to intravenous penicillin G