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 immuno deficiency virus) positive for 2 years presented an active secondary s yphilis 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. Se venty-two hours after onset of allergic manifestations, penicillin des ensitization was performed (subcutaneous followed by intravenous injec tions of increasing low doses), followed by classical intravenous peni cillin 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 sli de), FTA (fluorescent treponemal antibody absorption), MHA-TP (micro-h emaglutination assay for antibodies to Treponema pallidum), started to diminish after 2 months and all were negative a year later.