Pachymeningitis: Rheumatoid or Syphilitic?

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To the editor: Although the case of pachymeningitis discussed by Markenson and co-authors in the May issue (1) was presented lucidly with erudite immunologic discussion, one possible case is not considered by the authors: There is no mention in the report of serologic tests for syphilis. The hypertrophic pachymeningitis associated with syphilis has been described by Charcot and Joffroy (2), Gowers (3), and more recently Blackwood and Corsellis (4). Although the lesion when associated with syphilis most often involves the cervical and higher thoracic cord, lumbar involvement can also occur. The clinical presentation, of course, would be ascertained by the

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