Impending Aortic Rupture in a Patient with Syphilitic Aortitis

Abstract

We report the case of a 48-year-old man, admitted for atrial fibrillation with rapid heart rate and intense chest pain. A quick evaluation revealed a giant aortic aneurysm with severe aortic regurgitation and pericardial fluid without a trace of aortic dissection. Because of high suspicion of aortic rupture, an emergency surgery was planned, and a Bentall procedure was performed. On examination of the aortic wall revealing vertical wrinkling with a tree bark aspect, suspicion of syphilitic aortitis arose. The diagnosis was confirmed through postoperative serologic testing and histological examination. Histopathologic differential diagnosis, special treatment and follow-up are presented.

Emergency Department Diagnosis of Multiple Mycotic Aneurysms in an HIV-Positive Patient Using Point-of-Care Ultrasound

“…Mycotic aneurysms should always be suspected in immunocompromised patients and those with independent risk factors arterial aneurysms (i.e., smoking, cocaine use, hypertension, intravenous drug use) [ 34 ]. Our case is an example of multiple aneurysms arising in an HIV+ patient with a history of polysubstance abuse where PoCUS guided the rapid diagnosis of additional mycotic aneurysms not captured on initial CT imaging.…”

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 ].…”

“…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 ,…”

Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report

“…The most significant manifestation is known as syphilitic aortitis, which can lead to thoracic aneurysm formation, aortic valve disease, and coronary artery ostial stenosis. [1][2][3][4] The prognosis of patients with untreated syphilitic aortic aneurysms can be devastating, with 2-year mortality of almost 80%. 5,6 Therefore, correct diagnosis and appropriate surgical and medical therapies are crucial.…”