Asymptomatic cardiovascular syphilis with aortic regurgitation requiring surgical repair in an HIV-infected patient

• Type of Material: Article
• Authors: Daniel S. Graciaa, Emory University; Marina Mosunjac, Emory University; Kimberly A Workowski, Emory University; Russell Ryan Kempker, Emory University
• Language: English
• Date: 2017-09-14
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofx198
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 4
• Issue: 4
• Start Page: ofx198
• End Page: ofx198
• Keywords: HIV; aortic regurgitation; cardiovascular syphilis; aortic aneurysm
• Research Categories: Biology, Virology; Health Sciences, Pathology; Health Sciences, Medicine and Surgery

Abstract

A 47-year-old man with HIV infection presented 10 years after initial secondary syphilis diagnosis and treatment for routine follow-up. His HIV was well controlled on antiretroviral therapy. Rapid plasma reagin was 1:1, and TP-PA was reactive. Physical examination revealed a wide pulse pressure, a systolic murmur, and an early diastolic decrescendo murmur. Echocardiogram revealed moderate to severe aortic regurgitation, and subsequent computed tomography angiogram showed a 6.8-cm fusiform aneurysm of the proximal ascending aorta. Aortic valve and ascending hemiarch replacement were performed. Pathology showed adventitial inflammation with plasma cells, gumma-like amorphous areas surrounded by histiocytes, and giant cells with calcified plaques. Cardiovascular syphilis, while rare, remains a relevant cause of aortic aneurysm, even in previously treated patients. The physical exam can be critical in identifying this potentially fatal complication.