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Large vessel vasculitis: syphilitic aortitis as a reversible mimicker.

Maria João Cadório1, Fernando Albuquerque1, João Oliveira1

  • 1Unidade Local de Saúde de Coimbra.

ARP Rheumatology
|July 5, 2026
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Summary

Elderly patients with suspected large vessel vasculitis (LVV) should be evaluated for infectious mimics like syphilis. This case shows syphilitic aortitis mimicking LVV, resolving with penicillin treatment.

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Area of Science:

  • Cardiology
  • Infectious Diseases
  • Rheumatology

Background:

  • Large vessel vasculitis (LVV) in older adults often suggests giant cell arteritis.
  • It is crucial to rule out conditions that mimic LVV.
  • Elderly patients presenting with LVV symptoms require thorough differential diagnoses.

Purpose of the Study:

  • To report a case of syphilitic aortitis mimicking LVV in an elderly patient.
  • To emphasize the importance of considering infectious causes in atypical LVV presentations.
  • To highlight the diagnostic challenges and successful treatment of syphilitic aortitis.

Main Methods:

  • A case study of a 70-year-old woman with constitutional symptoms and elevated inflammatory markers.
  • Utilized FDG-PET imaging to assess for LVV.
  • Conducted serological testing for syphilis and confirmed diagnosis via aortitis confirmation.
  • Monitored response to antibiotic treatment.

Main Results:

  • Initial presentation included constitutional symptoms, elevated inflammatory markers, and FDG-PET findings suggestive of LVV.
  • Spontaneous improvement occurred without immunosuppression, prompting further investigation.
  • Positive treponemal serology led to the diagnosis of syphilitic aortitis.
  • Penicillin treatment resulted in complete resolution of vascular inflammation.

Conclusions:

  • Syphilitic aortitis can present as LVV in the elderly.
  • Infectious diseases should be considered in the differential diagnosis of LVV, especially in atypical or self-resolving cases.
  • Early diagnosis and appropriate antibiotic treatment are essential for managing syphilitic aortitis and preventing complications.