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Syphilitic Aortitis Diagnosis in Clinical Setting
Bruno Fernandes1, Arsénio Santos2, Lina Carvalho3
1Department of Pathological Anatomy, CHUC, Portugal.
Insights
This case report highlights a rare instance of tertiary syphilis causing an ascending aortic aneurysm, a condition seldom seen in the antibiotic era. Early diagnosis through serological and histopathological analysis is crucial for managing this rare cardiovascular syphilis manifestation.
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.
Introduction:
Cardiovascular syphilis can manifest as aortic aneurysms, aortic regurgitation and coronary ostial stenosis. Tertiary syphilis was the most commom reported cause of thoracic aortic aneurysm in the pre-antibiotic era, contributing to 5- 10% of cardiovascular deaths. However, in the 21st century, it has virtually disappered from the devoloping nations. Tertiay syphilis may develop in about one third of cases of untreated syphilis. In the pre-penicilin era, it was calculated that cardiovascular syphilis was responsible for 10-15% of clinical syphilis.
Methods:
We present a rare case of syphilitic aortitis in a era of highly effective antibiotics.
Results:
A 48-year-old man with no known clinical cardiac pathology went to emergency with an episode of chest pain of short duration and great intensity, being hospitalized with a differential diagnosis of coronary disease, ascending aortic aneurysm and aortic valve regurgitation. Two segments of the aorta, 5cm and 9.5cm length were observed, both had thickened wall (1cm), and firm plaques with diferent shapes and sizes. The intima of the aorta appeared rough and pitted, with the appearance of tree bark. There were heterogeneous lesions of the tunica media: hyalinization and calcification, macrophages aggregates, areas of hemorrhage and lymphoplasmacytic infiltrate forming vascular sheaths. Adventitia exhibited hyperplasia of nerve pathways with surrounding lymphoplasmocytic infiltrate. The diagnosis of syphilitic aortitis was purposed and serological analysis revealed positivity for Treponema pallidum. Patient underwent surgical correction of an aortic aneurysm.
Conclusion:
The serological positivity for Treponema pallidum and the histopathological study allowed the currently rare diagnosis of Ascending Aortic Aneurysm by Tertiary Syphilis. In the present scenario with early and widespread use of antibiotics, it is considered a very rare disease.
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