Osteolytic calvarial lesions as initial presentation of latent neurosyphilis.

We report a patient with human immunodeficiency virus infection whose initial presentation of neurosyphilis was painful calvarial lesions. A literature search reveals seven previous cases of calvarial involvement in early acquired syphilis but none in patients diagnosed with neurosyphilis. This patient emphasizes the need to consider atypical infections when encountering skull lesions, especially in the setting of human immunodeficiency virus co-infection.