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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.
Background:
Syphilis, caused by the bacterium Treponema pallidum, affects over 5 million people annually. Although rates have been declining, recent increases have been seen in men who have sex with men and in younger age groups.
Case Summary:
A 38-year-old man with polysubstance abuse presented with chest pain, dyspnea, and orthopnea after a viral prodrome. Laboratory tests showed elevated levels of troponin and B-type natriuretic peptide. Coronary angiogram was normal, and right heart catheterization indicated elevated filling pressures. An echocardiogram showed severe mitral and tricuspid regurgitation, along with a 1.5 × 1.0 cm vegetation on the mitral valve. Syphilis serologies were positive, and polymerase chain reaction analysis of valve tissue confirmed the presence of T pallidum.
Discussion:
Untreated syphilis can progress to tertiary syphilis, causing syphilitic aortitis. Mitral valve endocarditis is rare. This case emphasizes the importance of considering syphilis in cases of culture-negative endocarditis.
Take-Home Message:
Consider T pallidum infection in cases of culture-negative endocarditis.
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