Gummatous mitral valve endocarditis from tertiary syphilis.

Area of Science:

• Cardiology
• Infectious Diseases
• Neurology

Background:

• Tertiary syphilis can present with diverse and subtle symptoms, often eluding standard diagnostic protocols.
• Late-stage syphilis may manifest in cardiovascular and neurological systems, posing diagnostic challenges.

Observation:

• A 50-year-old gentleman with a history of syphilis presented with constitutional symptoms, neurological deficits, and signs of infective endocarditis.
• Imaging revealed hepatosplenomegaly, splenic infarcts, and cerebral lesions, while echocardiography showed severe mitral regurgitation due to a large vegetation.
• Despite negative initial infectious workup, positive serum treponemal antibodies (TPPA) and surgical findings suggested syphilitic valvulitis.

Findings:

• The patient was diagnosed with probable syphilitic endocarditis, complicated by severe mitral regurgitation and potential neurosyphilis.
• Surgical intervention revealed calcified valvular tissue suggestive of gumma.
• Standard antibiotic therapy may be insufficient to prevent late syphilitic complications.

Implications:

• This case underscores the importance of considering tertiary syphilis in the differential diagnosis of endocarditis and neurological disorders, especially in patients with a history of syphilis.
• Aggressive treatment combining surgery and prolonged antimicrobial therapy is crucial for managing syphilitic endocarditis.
• Current treatment guidelines may require re-evaluation to adequately address the prevention of late-stage syphilitic complications.