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Calvarial disease in secondary syphilis presenting as headache
  1. Jack Garnham1,
  2. Gemma Dawe1,
  3. Margherita Bracchi2,
  4. Nicholas Davies3,4
  1. 1 Radiology, Imperial College Healthcare NHS Trust, London, UK
  2. 2 HIV medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  3. 3 Neurology, Imperial College Healthcare NHS Trust, London, UK
  4. 4 Neurology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Jack Garnham, Radiology, Imperial College Healthcare NHS Trust, London, UK; jack.garnham{at}

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An adult man with well-controlled HIV (taking emtricitabine/tenofovir disoproxil fumarate and raltegravir) presented with 1–2 months of gradual-onset generalised headache, preceded by a diffuse symmetrical rash. He was afebrile and there were no abnormal neurological examination findings.

A CT scan of the head showed multiple lytic calvarial lesions, with destruction of the inner and outer tables and diploic space (figures 1 and 2). On MRI, the lesions were hyperintense on the T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, with restricted diffusion and enhancement (figure 3). A CT of his body was unremarkable apart from mild bladder wall thickening (a cystoscopy was subsequently normal).

Figure 1

CT scan of the head. Axial pre-treatment image showing multiple lytic calvarial lesions, involving the inner table, diploic space, and outer table. Magnified image of the left frontal lesion.

Figure 2

Superior view of a three-dimensional volume-rendered CT of the calvarium demonstrating the multiple lytic lesions.

Figure 3

MR scan of …

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  • Contributors All authors made a substantial contribution to the work. JG: in the drafting the initial effort, JG and GD: in acquiring and reviewing the images, and JG, GD, MB and ND: in manuscript review, editing and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed by Nick Silver, Liverpool, UK.

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