Acute coronary syndrome of very unusual etiology

Abstract

Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40-year-old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac-computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.

Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review

“…Late symptomatic syphilis is a rare systemic disease that can affect the skin, the mucous membranes, the circulatory system, the nervous system and the skeletal system. The incidence of tertiary syphilis decreases significantly with the introduction of penicillin in its early stage, but new cases of this disease are still being reported [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ,…”

“…Late syphilis involving the internal organs (Lues visceralis) most often affects the cardiovascular system [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ], mainly as aortitis that can develop aneurysms. Gummas can also be located in the lungs, the liver, the pancreas, the digestive tract and even the adrenal glands [ 73 , 74 , 75 , 76 , 77 ].…”

“…In order to illustrate this issue, the PubMed database was searched for cases of tertiary syphilis in the last 10 years. 22 cases of late skin syphilis (including one in Poland) [ 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 47 ], 21 cases of cardiovascular system syphilis [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ], five cases of systemic syphilis (the liver, the pancreas, the adrenal glands) [ 73 , 74 , 75 , 76 , 77 ], 11 cases of syphilis affecting bones [ 41 , 42 , 43 , 44 , 45 , 46 ,…”

“…Syphilis can be divided into primary and secondary stage early syphilis (within one year of infection), and late latent and symptomatic syphilis [ 10 ]. The number of cases of late symptomatic syphilis have dropped significantly since the implementation of penicillin to treat early syphilis [ 11 ], but occasional cases of tertiary syphilis are still noted [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ,…”

Association Between Endophthalmitis and the Incidence of Acute Coronary Syndrome in Patients With Ankylosing Spondylitis: A Nationwide, Population-Based Cohort Study

“…Although the etiopathogenesis of how infectious diseases increase ACS risk is unclear, many infectious etiologies have been found to have an association with ACS, including periodontitis (35), cholangitis (36), Helicobacter pylori (37), scrub typhus (38), syphilis (39), human immunodeficiency virus (40), herpes zoster (41), cytomegalovirus (42), hepatitis C virus (43), and coronavirus disease 2019 (44). However, none of the previous studies have investigated the relationship between endophthalmitis and ACS and the combined effect of AS and endophthalmitis on ACS risk.…”