Abstract
A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics. The diagnosis of the aortic aneurysm due to tertiary syphilis may be challenging due to deceptive clinical presentation and rarity of the disease in the western world. We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest. Further workup demonstrated a positive syphilis test. Untreated earlier stages of syphilis attribute to the development of the ascending aortic aneurysm. The patient was medically treated with IV penicillin and underwent surgical repair of the aortic aneurysm. Histopathology confirmed the diagnosis of syphilitic aortitis. Tertiary syphilis often presents several years after initial infection and usually after a latent phase, making it difficult to diagnose. Syphilitic aortic aneurysms may result in a high mortality rate in untreated patients. Therefore, a high index of suspicion is required for the early recognition of a syphilitic aortic aneurysm. Early treatment with antibiotic therapy and surgical repair of syphilitic aortic aneurysms can prevent life-threatening complications.
Highlights
The incidence of syphilis peaked during the second world war [1]
A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics
We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest
Summary
The incidence of syphilis peaked during the second world war [1]. Widespread use of antibiotics for the management of earlier stages of syphilis and coincidental treatment of other infectious conditions with anti-treponemal antibiotic therapy has nearly eradicated the cases of tertiary syphilis from western countries [2]. We describe an atypical case of ascending aortic aneurysm due to tertiary syphilis in the United States which is extremely rare and may create diagnostic challenges for the physicians. A 59-year-old man presented to the emergency room with worsening shortness of breath and orthopnea for two weeks He smokes five to six cigarettes daily for 10 years, denied alcohol drinking and recreational drug use. Computed tomography angiogram (CTA) of the chest was unremarkable for pulmonary embolism but demonstrated a large aortic root aneurysm measuring 5.9 cm (Figure 3). Workup for the etiology of aortic root aneurysms was only remarkable for a positive syphilis screening test that was confirmed with a positive T. pallidum particle agglutination assay (TP-PA). H&E stained pathological images with 40× (A), 100× (B), and 400× (C) magnification of the aortic root sample showing chronic inflammatory cells (plasma cells) in the adventitia marked by arrows
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