Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics

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.

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 ].…”

“…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 ,…”

“…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

“…Since ascending and thoracic aorta are rich in lymphatics, spirochetes have tropism for these aortic segments. [10][11][12][13] The tendency of spirochetes to dwell in the small vessels of the vasa vasorum leads to an adventitial chronic inflammation, mainly in the arterioles that perfuse the media layer. 6 The immune system response involves infiltration of plasmacytes and lymphocytes into the aortic wall layers, creating a diffuse and fibrous thickening of the intima.…”