Syphilitic aortitis

Cohen, Mauricio G.; Anderson, R. David; Navia, Daniel; Gallo, Amelia; Grinfeld, Liliana

doi:10.1002/1522-726x(200102)52:2<237::aid-ccd1057>3.0.co;2-e

Cited by 12 publications

(4 citation statements)

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“…Syphilitic aortitis of the ascending aorta represents the characteristic feature of cardiovascular syphilis. 7 The treponema invade the aortic vasa vasorum, causing lymphocytic and plasma cell perivascular in ltrates that lead to endarteritis obliterans, adventitial scarring, and patchy necrosis of the medial layer. Coronary ostial stenosis is common and has been attributed to the accumulation of scar tissue in the proximal aorta.…”

Section: Case Discussionmentioning

confidence: 99%

Clinical pathologic conference

2004

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A 29-year-old generally healthy male was in his usual state of health until May 2000, when he developed a spontaneous left leg deep vein thrombosis. This was followed by several months of progressively worsening weight gain (80 lb=36.3 kg), fatigue, dyspnea on exertion, orthopnea, lower extremity edema, and intermittent abdominal pain that was occasionally severe. H e also had developed many tender 'lumps' on his legs that resolved over 2 months. H is primary physician suggested that these were likely supercial thrombophlebitis. He was referred to a regional medical center, where further evaluation was undertaken. A chest X-ray showed cardiomegaly. An echocardiogram demonstrated a globally reduced ejection fraction of 40%. A coronary angiogram was interpreted as 'essentially normal'. H is creatinine was 1.9 mg=dl and his aspartate amino transferase and alkaline phosphatase were mildly elevated. Serum ferritin, ceruloplasmin, and serum and urine protein electrophoresis were normal and Lyme serology was negative. The patient was treated with an angiotensin-converting enzyme inhibitor and furosemide for presumed congestive heart failure. Computed tomography of the abdomen was performed because of persistent and unexplained abdominal pain. It revealed a 5-cm Type III thoracoabdominal aneurysm (Figure 1), but was otherwise unremarkable. At this point, the patient was referred to a tertiary medical center for further evaluation and management.The patient had no history of coronary artery disease. He denied diabetes, hypertension, hyperlipidemia, or family history of coronary artery disease. He was an active smoker (half a pack per day for 12 years). His medications included: lisinopril 20 mg daily, furosemide 80 mg daily, omeprazole 20 mg daily, trazodone 50 mg as needed for sleep, and lorazepam 5 mg as needed for anxiety. His allergies included penicillin and sulfa drugs, which caused rashes. His past medical history was signi cant for persistent neonatal jaundice during infancy. A liver biopsy at that time revealed 'non-speci c hepatitis and possible intrahepatic biliary atresia'. The jaundice resolved spontaneously and the patient's liver function had been unremarkable since that time. The patient also had a large atrial septal defect that was repaired at age 3 years without complications.The patient's father died at 40 years old of pulmonary embolism in the setting of esophageal cancer. H is mother had an immunogobulin (Ig) A de ciency and a history of H ashimoto's thyroiditis, but was otherwise healthy. The patient was single. H e did not drink alcohol or use illicit drugs. He had worked for a number of years as a farm laborer, but was currently working as a nursing assistant in a mental health facility.On systems review, he reported prior evaluation for a slightly unusual body habitus with central obesity and long limbs. Previous genetic and hormonal studies attempting to explain his morphology had been negative. He had chronic intermittent skin rashes described as pustular lesions that resembled chickenpox. The...

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Section: Case Discussionmentioning

confidence: 99%

Clinical pathologic conference

2004

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“…The ideal radiologic tool in aortitis is one that not only evaluates vessel aperture but one that also distinguishes active from inactive sites of disease with a high degree of sensitivity and specificity. [3] Cogan's syndrome [4] Kawasaki disease [5] Sarcoidosis [6] Spondyloarthropathies [7] Systemic lupus erythematosus [8] Rheumatoid arthritis [9] Behçet's syndrome [10] Myelodysplastic syndrome [11] Relapsing polychondritis [12] Infectious agents Syphilis [13] Tuberculosis [14] Bacteria [15,16] Streptococcus (rheumatic fever) […”

Section: Imaging Studiesmentioning

confidence: 99%

Aortitis

Mohan

Kerr

2002

Curr Treat Options Cardio Med

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Aortitis is defined as an inflammatory process that involves one or more layers of the aortic wall (internal elastic lamina, tunica media, and adventitia) and can be caused by multiple mechanisms. Clinical features are usually nonspecific and a high index of suspicion is required for making the diagnosis. Although noninvasive imaging studies are being increasingly used in evaluating patients for diagnosis, angiography remains the gold standard for confirming aortic involvement. When tissue is available, pathologic examination can aid in clarifying the diagnosis. Aortitis, irrespective of the underlying cause, frequently displays similar clinical, pathologic, and arteriographic features and therefore understandably presents a therapeutic and diagnostic dilemma. Whatever the cause, early identification and aggressive treatment is required in order to avert the potentially life-threatening sequelae. The treatment of aortitis is determined by the underlying cause. If diagnosed early, infectious aortitis responds to appropriate antimicrobial therapy, whereas noninfectious, immune-mediated aortitis requires immunosuppressive therapy. However, in many instances, primarily because of the delay in diagnosis, surgical intervention is necessary to treat the associated anatomic and physiologic sequelae. Less definitive and more controversial is the role of inflammation in both primary and secondary accelerated atherosclerosis of the aorta and its modality of treatment.

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“…Because tertiary syphilis has virtually been eradicated in the Western Hemisphere in recent years, syphilitic aortitis is rarely seen nowadays. The fact that Cohen et al [1] reported a case in this issue of Catheterization and Cardiovascular Interventions indicated that, although a dying disease, syphilitic aortitis is not yet dead.…”

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confidence: 99%