A Rare Case of an Abdominal Aortic Thrombus Secondary to Syphilitic Aortitis

Abstract

Syphilis is a sexually transmitted spirochete infection whose presentation depends on the stage of infection. Currently, due to antibiotic treatment, tertiary syphilis is a rare clinical entity. When present, it is characterized by neurosyphilis, gummas, and cardiovascular infection. We present a case of a 64-year-old male who came with abdominal pain due to allergic colitis and was incidentally found to have a mural thrombus of his abdominal aorta. Following a negative workup and no etiologic cause of the thrombus, the patient was diagnosed with syphilitic aortitis. Previous cases have been seen in patients who present with infarction due to aortic thrombosis secondary to syphilitic aortitis. Practitioners must be aware that patients with tertiary syphilis, such as this patient, could have aortic thrombosis without any signs of ischemia and are at risk for infarction.

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

“…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 ,…”

Abdominal vein thrombosis secondary to syphilis in an adolescent

“…Aortitis and other vasculopathies as a component of cardiovascular syphilis are caused by treponemal bacteria invading the vessel wall. The proliferation of bacteria on the vessel wall results in aneurysm, thrombosis, and vasculitis [1][2][3] . The incidence of venous thromboembolism (VT) reported to be 0.07 to 0.14 per 10.000 children, nevertheless the rate is increased more than 100 times in the inpatient children 4 .…”

“…About one-sixth of untreated syphilis patients develop latent-stage syphilis after a latency period for decades. Sequels of latent syphilis include the progression of inflammatory lesions in every part of the body which can lead to cardiovascular or organ dysfunction 1,11. The cardiovascular syphilis as a clinic manifestation of latent syphilis includes aneursym and thrombosis of the ascendan aorta 3 .…”