Spinal Tuberculosis in Pregnancy

Abstract

Treatment with dipirone produced satisfactory results. Highly active antiretroviral therapy (HAART) with a triple combination of lamivudine (3TC), zidovudine (AZT), and nelfinavir was started concomitantly, as was prophylactic treatment with sulfamethoxazole-trimethoprim. After 2 weeks the patient's lesions had regressed remarkably and shewas discharged from the hospital with HAARTand prophylactic sulfamethoxazole-trimethoprim therapy. The patient continued to respond positively to the treatment, with a complete remission of the lesions. At the 2 follow-up visits (30 and 90 days later) only disseminated dischromic patches could be seen as sequela. The course of syphilis is often atypical or dramatic in HIV seropositive patients and other authors have also described its unusually aggressive dermatological manifestations [1,2]. The classical clinical picture of malignant syphilis [1,2] was diagnosed in the present case. HIV co-infection made the secondary stage of syphilis more aggressive and altered the natural course of the disease: lesions had a fast progression and disseminated over the whole body in a few days, including the mouth and other major areas. Because the patient was immunocompromised by HIV she had a significantly higher likelihood of developing neurosyphilis [3]. Secondary syphilis can have a more aggressive course in HIV-infected patients who develop malignant syphilis [3]. The possibility of neurosyphilis should be promptly investigated. If testing is not possible, as in the present case, the patient should be presumptively treated for neurosyphilis. The lesions will typically respond rapidly to penicillin.