Aseptic Syphilitic Meningitis in an HIV-Negative Patient with Concomitant Primary and Secondary Syphilis

Antonio R. Jimenez, Paige Hoyer, Michael Wilkerson

Research output: Contribution to journalArticlepeer-review


Background: Syphilis is a sexually and vertically transmitted disease caused by the Treponema pallidum species. Aseptic syphilitic meningitis (ASM) is a subcategory of neurosyphilis. Neurosyphilis is typically considered a tertiary manifestation of syphilis; however, ASM typically occurs within six months of exposure and may be concurrent with the rash of secondary syphilis. Case Presentation: A 58-year-old immunocompetent male presented to the dermatology clinic with an erythematous morbilliform rash that involved his trunk and upper extremities. He was prescribed benzonatate 100 mg 3 weeks prior for cough and was diagnosed with a drug-induced morbilliform rash. The patient was seen one month later by urology for a penile ulcer. At his urology appointment, a rapid plasmin reagin test was done and resulted positive with a titer of 1:256. He was referred to dermatology again and was noted to have a diffuse, copper-colored maculopapular rash involving the palms and soles. During this appointment, the patient complained of a 4-week headache and was found to have nuchal rigidity. He was admitted for neurosyphilis work up, including CSF and CSF-VDRL examination. His neurologic symptoms improved with IV Penicillin G. Repeat RPR testing at six months follow up confirmed adequate treatment and his RPR declined from 1:256 to 1:4. Conclusion: We present a case of ASM in an immunocompetent individual with concomitant primary and secondary syphilis. Dermatologists are trained to recognize the cutaneous manifestations of syphilis, but also should be familiar with the variable presentations of the disease, including the early neurological findings of ASM.

Original languageEnglish (US)
Pages (from-to)361-364
Number of pages4
JournalSKIN: Journal of Cutaneous Medicine
Issue number4
StatePublished - Jul 12 2020


  • general dermatology
  • medical dermatology
  • sexually transmitted infections
  • syphilis

ASJC Scopus subject areas

  • Dermatology


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