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In a minority of cases, the bacteria can invade the central nervous system and produce meningovascular syphilis, an inflammatory vasculopathy that can mimic neurovascular disease by manifesting as an ischemic stroke. Consideration and timely recognition of this manifestation of syphilis infection is paramount because if left untreated treponemal induced arteritis can progress, keeping patients at increased risk for additional strokes. We report the case of a 36-year-old man whose untreated HIV placed him at increased risk for the development of meningovascular syphilis. We also describe the use of an acceptable alternative therapy after the patient developed an allergic reaction to penicillin during treatment. This case highlights the importance of maintaining a high level of suspicion for infectious etiologies in patients presenting with stroke-like symptoms without conventional risk factors for neurovascular disease. In this case, such suspicion enabled a timely diagnosis and treatment, preventing further complications of untreated syphilis.<\/jats:p>","DOI":"10.1177\/23247096261454453","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:17:44Z","timestamp":1779193064000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Ischemic Stroke Secondary to Meningovascular Syphilis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5201-605X","authenticated-orcid":false,"given":"Marissa","family":"Nicolas-Cagigal","sequence":"first","affiliation":[{"name":"University of Texas Medical Branch"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0979-4904","authenticated-orcid":false,"given":"Aaron","family":"Lee","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Sarria","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine"},{"name":"University of Texas Medical Branch"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.34.4.553"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad437"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.17362"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1655101"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/21688370.2016.1143543"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.72976"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2017-001754"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.800383"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-020-01415-6"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-022-07700-z"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurol.2017.07.014"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/19418744251355654"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.54563"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.olq.0000230481.28936.e5"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.12734"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0b013e31824c0e62"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1309\/AJCPWSL3G8RXMCQR"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/163.6.1201"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.35.9.1368"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7004a1"},{"key":"e_1_3_5_22_2","volume-title":"Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV [Internet]","author":"National Institutes of Health; Centers for Disease Control and Prevention; HIV Medicine Association of the Infectious Diseases Society of America","unstructured":"National Institutes of Health; Centers for Disease Control and Prevention; HIV Medicine Association of the Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV [Internet]. Rockville (MD): US Department of Health and Human Services. 2002\u2013 [updated 2026 Feb 25; cited 2026 Mar 22]. 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