Tuberculous and syphilitic meningitis in a patient infected with the human immunodeficiency virus.

This report examines simultaneous tuberculous and syphilitic meningitis in a patient with human immunodeficiency virus (HIV). The 41-year-old homosexual patient presented with meningitis and hydrocephalus. His CD4+ and CD8+ T-lymphocyte counts per microliter were 60 and 71, respectively. His clinical presentation was of a rapid-onset cerebral attack incompatible with tuberculous meningitis. Imaging indicated fatal bilateral cerebral infarction at the basal nuclei, and basal meningitis. We believe that syphilitic meningitis in HIV exacerbated the central nervous system (CNS) damage caused by tuberculosis and syphilis. The combination of three pathogens, Mycobacterium tuberculosis, Treponema pallidum, and HIV, has a great potential to cause serious CNS damage.