Syphilitic Aortitis Diagnosis in Clinical Setting.

Area of Science:

• Cardiology
• Infectious Diseases
• Pathology

Background:

• Cardiovascular syphilis, historically a significant cause of aortic aneurysms, has become rare due to effective antibiotics.
• Tertiary syphilis can develop in approximately one-third of untreated cases, potentially leading to severe cardiovascular complications.
• Pre-antibiotic era data indicated cardiovascular syphilis accounted for 5-15% of cardiovascular deaths and clinical syphilis cases.

Observation:

• A 48-year-old male presented with acute chest pain, initially suspected to be coronary disease or aortic pathology.
• Imaging revealed thickened aortic walls with plaque-like intimal changes and heterogeneous lesions in the tunica media, including hyalinization, calcification, and inflammation.
• Histopathological examination showed characteristic syphilitic aortitis with lymphoplasmacytic infiltrates and vascular sheath formation.

Findings:

• Serological testing confirmed active infection with Treponema pallidum.
• The patient was diagnosed with an ascending aortic aneurysm secondary to tertiary syphilis.
• Surgical correction of the aortic aneurysm was performed.

Implications:

• This case underscores the importance of considering syphilis in the differential diagnosis of aortic aneurysms, even in the current era of advanced antibiotics.
• Early and accurate diagnosis via serological and histopathological methods is vital for timely intervention and management of syphilitic cardiovascular disease.
• The rarity of this condition emphasizes the success of antibiotic therapy in preventing tertiary syphilis complications but highlights the need for continued vigilance.