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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
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.
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.
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