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Syphilitic Mitral Valve Endocarditis: Diagnostic Challenges and Clinical Management

Roshan Bista1, Mohamed Zghouzi1, Victoria Odeleye1

  • 1Department of Cardiovascular Sciences, Ascension St Thomas Hospital, University of Tennessee Health Science Center, Nashville, Tennessee, USA.

JACC. Case Reports
|August 7, 2025
PubMed
Abstract

Insights

Syphilis can cause rare mitral valve endocarditis, even in young adults. Early diagnosis of Treponema pallidum infection is crucial for culture-negative endocarditis cases.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Bacteriology

Background:

  • Syphilis, caused by Treponema pallidum, affects millions globally, with rising incidence in specific demographics.
  • Tertiary syphilis can lead to severe cardiovascular complications like syphilitic aortitis.

Observation:

  • A 38-year-old male with polysubstance abuse presented with symptoms of heart failure and a viral prodrome.
  • Diagnostic workup revealed elevated cardiac biomarkers, normal coronary angiogram, and echocardiographic evidence of severe mitral regurgitation with a vegetation.
  • Positive syphilis serologies and PCR confirmation of T. pallidum in valve tissue established the diagnosis.

Findings:

  • The case highlights a rare presentation of infective endocarditis caused by Treponema pallidum affecting the mitral valve.
  • This emphasizes the challenges in diagnosing culture-negative endocarditis, where syphilis should be considered.

Implications:

  • Clinicians should consider syphilis in the differential diagnosis of culture-negative endocarditis, particularly in at-risk populations.
  • Prompt identification and treatment of Treponema pallidum infections are vital to prevent severe cardiovascular sequelae.
Keywords:
echocardiographyendocarditismitral valve

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