Neurosífilis meningovascular y gomatosa cerebral concomitante, en paciente seronegativo para virus de inmunodeficiencia humana

neurosyphilis (ns) is caused by the presence of treponema pallidum (tp) spirochete within the central nervous system (cns), mainly affecting the meninges and cerebrospinal fluid (csf). 5% to 10% of untreated syphilitic patients are deemed to develop symptomatic ns1. its incidence and clinical spectrum have changed over the years with prevalence of early clinical stages of meningitic and meningovascular (mv) ns and exceptional occurrence of late clinical stages (tabes dorsalis, general paresis, and gummata) in the age of antibiotics. the case under analysis deals with aggressive mv and concomitant brain gumma (bg) ns. the case subject is a human inmunodeficiency virus (hiv)-seronegative, 44-year-old woman with 2-year symptomatic latency. her medical record showed recurrent sensorimotor vascular involvement, fast cognitive damage and chronic, daily cephalea. she met clinical diagnosis, cerebrospinal fluid and serologic criteria for ns. brain computerized tomography (ct) and magnetic resonance (mr) reported lenticulostriate artery infarction and bilateral ganglionic syphilitic gummata. she underwent penicillin g-based treatment, making progress with neurological, cognitive-motor sequelae. although ns has anticipated and speeded up its several clinical stages in connection with hiv/syphilis co-infection, the peculiarity of this case is the concurrence of early and late ns manifestations in hiv-seronegative patient. the conclusion is that ns is a disease that still prevails and that appropriate diagnosis and treatment prevent irreversible neurological sequelae.