Ruptured Syphilitic Aneurysm: A Cause of Sudden Death in a Man with Human Immunodeficiency Coinfection

Ro, Ayako; Mori, Shinjiro; Kageyama, Norimasa; Chiba, Shoetsu; Mukai, Toshiji

doi:10.1111/1556-4029.14046

Cited by 5 publications

(3 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One of the men was coinfected with HIV. This case from Japan highlights the importance of screening for HIV in patients found to have syphilis, and vice versa [8]. Of note, in both cases, the syphilis serology was positive.…”

Section: Discussionmentioning

confidence: 62%

See 1 more Smart Citation

A ruptured thoracic aortic aneurysm and the difficulties of confirming syphilis

Hulme

Werno

Spark

2023

Forensic Sci Med Pathol

View full text Add to dashboard Cite

A 43-year-old woman died suddenly and was found at PM to have a ruptured thoracic aortic aneurysm. The endothelial surface of the aorta showed a 'tree-bark' appearance. Histology of the aneurysm wall showed a patchy, mainly perivascular, plasma cell infiltrate. Multiple spirochete-like organisms were identified on T. pallidum IHC. However, PM syphilis serology (screen including rapid plasma reagin (RPR) and T. pallidum particle agglutination (TPPA)) on femoral blood was negative. PCR testing on FFPE aortic wall tissue was negative. Further history revealed routine antenatal syphilis screening tests had been negative, no known history or risk of exposure to syphilis or other treponemes. This case raises the possibility of false negative syphilis testing. While acknowledged in RPR testing, with the modern testing regime using multiple methods, the rate of false negative results is now thought to be markedly reduced, and false positive results are a much greater problem in clinical medicine. The most common cause of false negative results is early in primary infection before an immune response has been mounted and in those patients that are immunocompromised. False negative results are also more often seen in tertiary syphilis, as in this case. Newer testing methods which include 16S rRNA sequencing have become available and early discussion with a microbiologist would be recommended. Strong macroscopic and microscopic suggestion of syphilis as the cause of the aneurysm makes it necessary to include the possibility of infection in the Post Mortem Report to Coroner as this will have implications for her sexual partners and children.

show abstract

Section: Discussionmentioning

confidence: 62%

“…This includes two case reports of men who died from ruptured syphilitic aortic aneurysms [7,8]. One of the men was coinfected with HIV.…”

Section: Discussionmentioning

confidence: 99%

A ruptured thoracic aortic aneurysm and the difficulties of confirming syphilis

Hulme

Werno

Spark

2023

Forensic Sci Med Pathol

View full text Add to dashboard Cite

show abstract

“…51 However, untreated or incomplete treatment of syphilis can progress to syphilitic aortitis and syphilitic aneurysms, which are potentially life-threatening. 52 The early diagnosis of either is difficult, because uncomplicated aortitis is asymptomatic. 53 Furthermore, syphilitic aortitis is more common and has a more rapid progression in patients with syphilis and HIV coinfection compared with patients with syphilis but without HIV.…”

Section: Sexual Health Risk Factorsmentioning

confidence: 99%

Sexual orientation, gender identity, and gender expression: From current state to solutions for the support of lesbian, gay, bisexual, transgender, and queer/questioning patients and colleagues

West-Livingston

Dittman

Park

et al. 2021

Journal of Vascular Surgery

View full text Add to dashboard Cite

Many of the systemic practices in medicine that have alienated lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals persist today, undermining the optimal care for these patients and isolating LGBTQ medical providers from their colleagues. The 2020 Task Force on Diversity, Equity, and Inclusion Report recently published by the Society for Vascular Surgery marked the first publication advocating for the inclusion of sexual orientation and sexual identity in the development of initiatives promoting and protecting diversity across vascular surgery. Vascular providers should be aware that it is crucial to cultivate an environment that is inclusive for LGBTQ patients because a large proportion of these patients have reported not self-disclosing their status to medical providers, either out of concern over potential personal repercussions or failing to recognize the potential relevance of LGBTQ status to their medical care. Safe Zone training has provided a standard resource for providers and staff that can be integrated into onboarding and routine training. Clarifying the current terminology for sexual orientation and identity will ensure that vascular providers will recognize patients who could benefit from screening for additional vascular risk factors relevant to this population related to sexual health, social behavior, physical health, and medical therapies. The adoption of gender neutral language on intake forms and general correspondence with colleagues is key to reducing the unintended exclusion of those with LGBTQ identities in both inpatient and outpatient environments. In many locales across the United States, the professional and personal repercussions for openly reporting LGBTQ status persist, complicating efforts toward quantifying, recognizing, and supporting these patients, practitioners, and trainees. Contributing to an inclusive environment for patients and peers and acting as a professional ally are congruent with the ethos in vascular surgery to treat all patients and colleagues with respect and optimize the healthcare of every vascular patient.

show abstract