Cerebral Syphilitic Gumma

To the Editor: The Image in Clinical Medicine involving syphilitic gummas in a patient with human immunodeficiency virus (HIV) infection who presented with focal seizures (Oct. 10 issue) 1 caused us much concern. Our concern was heightened by the letter from Suarez et al. about a syphilitic gumma in an HIV-negative patient with focal seizures. 2 Both patients had important focal neurologic findings coupled with severely abnormal magnetic resonance imaging (MRI) findings (in the case of the HIV-positive patient, there was a clear mass effect from the lesions and subfalcine herniation). Both patients underwent a lumbar puncture on the basis of which, . . .