Ischemic Stroke Secondary to Meningovascular Syphilis

Syphilis can present in a wide variety of ways, earning its reputation as “the great imitator”. In a minority of cases, the bacteria can invade the central nervous system and produce meningovascular syphilis, an inflammatory vasculopathy that can mimic neurovascular disease by manifesting as an ischemic stroke. Consideration and timely recognition of this manifestation of syphilis infection is paramount because if left untreated treponemal induced arteritis can progress, keeping patients at increased risk for additional strokes. We report the case of a 36-year-old man whose untreated HIV placed him at increased risk for the development of meningovascular syphilis. We also describe the use of an acceptable alternative therapy after the patient developed an allergic reaction to penicillin during treatment. This case highlights the importance of maintaining a high level of suspicion for infectious etiologies in patients presenting with stroke-like symptoms without conventional risk factors for neurovascular disease. In this case, such suspicion enabled a timely diagnosis and treatment, preventing further complications of untreated syphilis.