Latent cardiovascular syphilis as a cause of incidental, isolated aortitis

A male patient in his 60s was referred through for rheumatology care with features on fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) PET-CT imaging that were highly suggestive of aortitis. There was no history of temporal headache or visual loss, nor any cardiorespiratory, claudicant or constitutional symptoms. Echocardiography and CT angiogram of the aorta excluded aortic valve disease but confirmed a dilated aortic root with irregular thoracic aortic diameters. Sexual history included both male and female partners, although last intercourse had occurred more than three decades prior to referral.Aortitis is often considered synonymous with systemic autoimmune rheumatic diseases, requiring immunosuppression. However, in this instance, testing for syphilis was undertaken and confirmed infection. The patient was diagnosed with latent cardiovascular syphilis and treated with prednisolone and benzathine benzylpenicillin. To date, he remains well and has not had any complications of aortitis.