[Surgical treatment of a patient with syphilitic aortitis]. / Khirurgicheskoe lechenie patsienta s sifiliticheskim aortitom.

Syphilitic aortitis is a rare disease caused by Treponema pallidum affecting the aorta and leading to inflammation. Syphilitic aortitis is one of the causes of aortic aneurysms. This article presents surgical treatment of a patient with syphilitic aortitis and thoracic aortic aneurysm. This clinical case confirms the difficulties of surgical treatment.

[Emergency Operation for Impending Rupture of Syphilitic Aortic Aneurysm with Left Coronary Ostial Stenosis:Report of a Case].

Syphilis is known as a cause of syphilitic aortitis. Chronic inflammation leads to formation of syphilitic aneurysm which often is found at the ascending aorta. If the inflammation spreads to the aortic root, stenosis of coronary ostium or aortic valve regurgitation are caused. We report a case that impending rupture of syphilitic aneurysm at ascending aorta with stenosis of left coronary ostium. The patient is a 49 years old male, and his chief complaint was chest pain which gradually became stronger. Computed tomography (CT) identified a large ascending aneurysm with a maximum diameter of 66 mm. The serum rapid plasma regain( RPR) test and the fixed Treponema pallidum latex agglutination( TPLA) test were positive. We diagnosed impending rupture of aneurysm, and performed emergency ascending aorta replacement. The aortic aneurysm was strongly adherent to the surrounding tissues. Pathological findings showed mesaortitis, which was consistent with syphilitic aneurysm. We started oral administration of amoxicillin hydrate from postoperative day 8. The patient did well, and was discharged on postoperative day 18. During his hospitalization, we performed enhanced coronary CT, and found stenosis of left coronary ostium. But he had no symptoms, so he got percutaneous coronary intervention after his discharge. Now the number of patients of syphilis is increasing in Japan. So it is important to know its characteristics and proper treatment.

[Chest pain and chronic heart failure as a manifestation of tertiary syphilis: clinical case].

In cardiological practice, there may be patients with chest pain and heart failure of a specific etiology, including an association with cardiovascular syphilis. This article describes a 49-year patient with chest pain, heart failure, and neurological symptoms associated with ongoing tertiary syphilis. The history included an antisyphilitic treatment 30 years before the current hospitalization. Further evaluation confirmed neuro- and cardiovascular syphilis with severe aortic regurgitation and syphilitic myocarditis. Tertiary syphilis is a rare but relevant challenge for various medical specialists, including cardiologists. This pathology requires increased medical alertness and interdisciplinary interaction for early diagnosis, effective and safe treatment, and improved prognosis.

Rare Presentation of a Syphilitic Aneurysm of the Infrarenal Aorta with Contained Rupture.

We report, to our knowledge, the first case of a rare syphilitic infrarenal aortouniiliac aneurysm with contained rupture that presented with midepigastric abdominal pain. Review of the patient's medical history revealed untreated syphilis and poorly treated congestive heart failure. Given his comorbidities, the patient was treated with an emergent endovascular aneurysm repair. His 30-day postoperative recovery period was uneventful, and follow-up imaging revealed complete resolution of the aneurysms. Syphilitic infrarenal aortic aneurysm is currently considered a rare entity in this era of antibiotics. The present article provides a brief case report and short review of literature pertaining to syphilitic aortic aneurysms.

Syphilitic aortic aneurysm.

The aim of this study was to outline the clinical features of syphilitic aortic aneurysm. The study materials were based on a comprehensive literature review of publications on syphilitic aortic aneurysm published between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly in the ascending aorta in either a saccular or a fusiform shape. Syphilitic aortic aneurysm was often complicated by aortic valve insufficiency (in almost half of the patients), and by a coronary artery/ostium lesion in 16.5% of the patients. Aortic valve operation was necessary in one fourth, and coronary artery surgery accounted for less than one fifth of patients warranting a surgical treatment. Although there was no difference in the survival rates between the surgically and conservatively treated patients, an aggressive treatment should be performed when diagnosis is made due to the potential risks of aneurysm rupture and sudden death.

Syphilitic Aortitis Diagnosis in Clinical Setting.

INTRODUCTION: Cardiovascular syphilis can manifest as aortic aneurysms, aortic regurgitation and coronary ostial stenosis. Tertiary syphilis was the most commom reported cause of thoracic aortic aneurysm in the pre-antibiotic era, contributing to 5- 10% of cardiovascular deaths. However, in the 21st century, it has virtually disappered from the devoloping nations. Tertiay syphilis may develop in about one third of cases of untreated syphilis. In the pre-penicilin era, it was calculated that cardiovascular syphilis was responsible for 10-15% of clinical syphilis. METHODS: We present a rare case of syphilitic aortitis in a era of highly effective antibiotics. RESULTS: A 48-year-old man with no known clinical cardiac pathology went to emergency with an episode of chest pain of short duration and great intensity, being hospitalized with a differential diagnosis of coronary disease, ascending aortic aneurysm and aortic valve regurgitation. Two segments of the aorta, 5cm and 9.5cm length were observed, both had thickened wall (1cm), and firm plaques with diferent shapes and sizes. The intima of the aorta appeared rough and pitted, with the appearance of tree bark. There were heterogeneous lesions of the tunica media: hyalinization and calcification, macrophages aggregates, areas of hemorrhage and lymphoplasmacytic infiltrate forming vascular sheaths. Adventitia exhibited hyperplasia of nerve pathways with surrounding lymphoplasmocytic infiltrate. The diagnosis of syphilitic aortitis was purposed and serological analysis revealed positivity for Treponema pallidum. Patient underwent surgical correction of an aortic aneurysm. CONCLUSION: The serological positivity for Treponema pallidum and the histopathological study allowed the currently rare diagnosis of Ascending Aortic Aneurysm by Tertiary Syphilis. In the present scenario with early and widespread use of antibiotics, it is considered a very rare disease.

Secondary syphilis presenting with aortitis and coronary ostial occlusion.

Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection.

Syphilitic Aortic Regurgitation - An Unusual Case.

Tertiary syphilis with cardiovascular lesions are rarely seen nowadays. Here we report a case of a 43 year old patient diagnosed with aortic regurgitation due to syphilitic aortitis.

Surgery for Ascending Aortic Aneurysm and Aortic Valve Insufficiency in Conditions of Active Proceeding Syphilitic Aortitis and Valvulitis.

A syphilitic aortitis is a late cardiovascular lesion of tertiary syphilis that has become exceptionally rare in the antibiotic era but not eradicated completely. Syphilitic aortitis of ascending aorta complicates in ascending aortic aneurysm formation and aortic valve regurgitation, both requiring surgical treatment. After surgery, lifelong surveillance of the remainder of the aorta is recommended because of a priori supposed high incidence of delayed involvement of noninvolved aortic segments. A 3-year follow-up result of surgery of syphilitic ascending aortic aneurysm with aortic valve regurgitation in condition of active ongoing syphilitic aortitis and valvulitis is described with addressing the dimensions of remaining aortic segments. This case demonstrates that the dilatation of the remainder of the aorta does not occur during 3 years, at least when anti-syphilitic course of antibiotic is used just after operation without additional treatment during the follow-up period. A few reports on surgical treatment of syphilitic aneurysms of the ascending aorta are discussed.

Tertiary Cardiovascular Syphilis Presenting as Aortic Regurgitation, Aortitis, Thrombus, and Coronary Artery Occlusion, Requiring Percutaneous Coronary Intervention.

BACKGROUND Heart failure is caused by coronary artery disease, valvular disease, and arrhythmias and is highly treatable with recent technology. However, the incidence of syphilis is increasing worldwide. This case report describes tertiary cardiovascular syphilis, accompanied by aortic regurgitation, syphilitic aortitis complicated by thrombus of the ascending aorta, and coronary artery occlusion, requiring percutaneous coronary artery intervention. CASE REPORT A 51-year-old Japanese man with no significant medical history was admitted to the hospital for worsening shortness of breath on exertion. On physical examination, there was no edema in either lower leg. Chest X-rays showed an enlarged heart and pulmonary congestion, and echocardiography showed a left ventricular ejection fraction of 18%, with full circumferential wall motion impairment. Heart failure was diagnosed, and the patient was found to have severe coronary artery disease and aortic regurgitation. He underwent percutaneous coronary intervention (PCI) for his coronary artery occlusion and was treated with medications for heart failure. Two months later, his condition improved, and PCI was performed for the revascularization of the remaining coronary artery. After PCI was completed, the patient was evaluated for vasculitis. The aortic wall lesion was likely a result of non-active syphilitic aortitis, and the results of serological tests of syphilis were positive. Therefore, we concluded that the diagnosis was cardiovascular syphilis. CONCLUSIONS This case report has highlighted the need for clinicians to be aware of the cardiovascular findings in syphilis, including syphilitic aortitis, particularly at this time, when the global incidence of syphilis is increasing.

[Syphilitic mesaortitis].

A rise in the incidence of latent and late forms of neuro- and visceral syphilis significantly complicates diagnostics of the disease in patients admitted to emergency medicine clinics. Syphilis is believed to be a cause of roughly 0.5% of all cardiopathies. Late syphilitic lesions of the cardiovascular system (cardiovascular syphilis) occur in 0.25-0.96% patients in need of therapeutic treatment, 93.4% of them present with mesaortitis but its life-time diagnosis is possible only in 10% of the cases. Syphilitic lesions in the aorta are especially well apparent at the points of its branching into coronary arteries of the heart and aortic arch. One of the main consequences of syphilitic aortitis is the narrowing of coronary arteries frequently complicated by atherosclerosis, coronary thrombosis, and the resulting myocardial infarction. Another severe complication of syphilitic aortitis is progressive aortic valve insufficiency (in 25-50% of the patients) related to dilatation of the valve ring affected by inflammation. Some patients develop bacterial endocarditis of the aortic valve. Close localization of the coronary artery junction and the aortic valve account for a combination of aortic valve insufficiency and coronary insufficiency in patients with syphilitic process in the initial part of aorta. A case report is presented.

Combined Cardiovascular Syphilis and Aortic Valve Stenosis (Due to a Congenitally Unicuspid Valve).

Described herein is a 53-year-old man who underwent resection of a fusiform aneurysm of the ascending aorta, and excision of a congenitally malformed stenotic unicuspid aortic valve. Examination of the wall of the aortic aneurysm disclosed classic features of syphilis. Although some degree of pure aortic regurgitation is common in patients with aortic syphilis, the presence of associated aortic valve stenosis, such as occurred in this patient, has been mentioned in only 4 previous publications, none of which included morphologic examination of the ascending aorta or aortic valve.

Combined Cardiovascular Syphilis and Type A Acute Aortic Dissection.

The occurrence of acute aortic dissection with the initiating tear in the ascending aorta superimposed on cardiovascular syphilis is an exceedingly rare occurrence. Such was the case, however, in a recently seen patient who presented with typical features of acute dissection (type A). Operative repair yielded the entire ascending aorta to examine both grossly and histologically and classic features of both conditions were observed.

Syphilitic aortitis: chronic left coronary ostial occlusion and aortic regurgitation with aortitis.

Before the discovery of penicillin, tertiary syphilis was the most common cause of thoracic aneurysms, but now cardiovascular syphilis is a clinical rarity in developed countries. We report a case of 69-year-old man who presented with sudden onset breathlessness that worsened insidiously for 2 months. Diagnosis of syphilitic aortitis was confirmed by laboratory findings, contrast computed tomography, echocardiography and coronary angiography. The patient underwent successful coronary artery bypass graft, aortic valve replacement and ascending aortic replacement. A high level of suspicion and awareness is needed for the diagnosis of the now rare disease.

Syphilitic aneurysm.

Syphilis was once the most common cause of aortic aneurysm. For the last 60 years syphilis has been well controlled in the UK population. However, we present the recent case of a 52-year-old female black South African immigrant who was found to have a syphilitic aneurysm.

[Concomitant syphilitic aneurysms of the thoracic and abdominal aorta. Case report]. / Aneurismas concomitants da aorta torácica e abdominal de etiologia sifilítica. Caso clinico.

The aneurismatic aortic disease is one of the most frequent conditions challenging the vascular surgeon. It can be caused by atherosclerosis, vasculitis, trauma, infection or others. The treatment, even when elective, can be associated to high rates of morbid-mortality, related to the etiology, anatomic location and type of treatment. The authors describe the case of a patient with concomitant syphilitic aneurysms of the descending thoracic aorta, pararenal and aortic bifurcation. The diagnostic presumption was supported by clinical and epidemiology data (the patient was treated for a syphilitic saccular infrarenal aortic aneurysm 5 years before). The etiology was confirmed by the pathological studies of the surgical specimen.

Syphilitic pancreatitis: A rare mimicker of our time.

We present an unusual case of syphilitic pancreatitis and ascending aortitis in a 41-year-old HIV-negative male patient presenting to a tertiary institution with obstructive jaundice. After a battery of investigations that included computed tomography (CT) and 18F-labelled fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) imaging, syphilis serology and histology, a diagnosis of tertiary syphilis was made. The patient responded favourably to antibiotics, with resolution of all lesions on FDG PET/CT 13 weeks after initiation of therapy. Even though tertiary syphilis is a rare entity, it should be earmarked as a mimicker of other pathological conditions, including, in this case, primary pancreatic malignancy.

A giant syphilitic aneurysm in a young human immunodeficiency virus sero-positive individual.

A 35-year-old, human immunodeficiency virus sero-positive male presented with huge mediastinal mass for evaluation. After contrast enhanced computed tomography (CECT) angiogram, aneurysm of arch of aorta was diagnosed. The patient also proved to be co-infected with syphilis, which is the aetiological cause of aneurysm in this case. The present report highlights the need to suspect, diagnose and treat dual infections in individuals with high risk behaviour.