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Atypical Presentation of Tertiary Syphilis.
Paul Cholley1, Julien Stievenart1, Damien Fayard1
1From the Departments of Radiology (P.C., L.C.) and Internal Medicine (J.S., D.F.), University Hospital Gabriel Montpied, 58 rue Montalembert, F-63000 Clermont-Ferrand, France; and Department of Radiology, Institut Pascal, TGI, UMR6602 CNRS SIGMA Université Clermont Auvergne, Clermont-Ferrand, France (L.C.).
Tertiary syphilis can cause severe cardiovascular issues, including thoracic aortitis and stroke, even with atypical initial symptoms like vision loss. This case highlights the importance of considering syphilis in complex vascular presentations.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Radiology
Background:
- Tertiary syphilis, a late stage of infection, can manifest with cardiovascular complications years after initial exposure.
- Cardiovascular involvement in syphilis often presents as syphilitic aortitis.
Observation:
- A 49-year-old male presented with sudden bilateral vision loss, an atypical symptom for tertiary syphilis.
- Contrast-enhanced CT angiography revealed widespread vascular abnormalities.
Findings:
- The patient exhibited thoracic aortitis, carotid artery occlusion, coronary artery stenosis, ischemic stroke, myocardial infarction, and intracardiac thrombi.
- Postmortem autopsy confirmed syphilitic aortitis and positive syphilis serology.
Implications:
- This case underscores the critical need for considering syphilis in the differential diagnosis of complex cardiovascular and neurological events.
- Early recognition and treatment of syphilis are crucial to prevent severe, potentially fatal, vascular complications.
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