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Neurosyphilis can present with a wide range of different presentations. For this reason, it has been called the “the great imitator”. Limbic encephalitis mimicking HSV encephalitis is an under recognized manifestation of neurosyphilis. Co-infection with HIV may alter the course of neurosyphilis and cause more atypical and aggressive presentations to occur. The author presents a case of mesial temporal encephalitis caused by neurosyphilis in a man with concomitant HIV infection. A review of the literature shows that this is not a sparse presentation of neurosyphilis. The pathophysiology and clinical implications are reviewed.
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