Aortitis sifilítica: manifestación olvidada de la sífilis / Syphilitic aortitis: forgotten manifestation of syphilis

Resumen La sífilis es una infección bacteriana producida por el Treponema pallidum (espiroqueta). Consta de varias etapas: primaria, secundaria y terciaria, según el tiempo de evolución desde el momento en que se adquiere la infección. Cada etapa comprende diferentes manifestaciones clínicas; los síntomas cardiovasculares forman parte de la sífilis terciaria, en cuyo caso la aortitis sifilítica es la principal forma de presentación. Se expone el caso de un paciente que consultó por déficit neurológico focal, en quien por medio de estudios de extensión se documentó neurosífilis e insuficiencia valvular aórtica severa secundaria a perforación de la válvula coronaria derecha, que requirió recambio valvular aórtico por bioprótesis. Adicionalmente, se hace una revisión de las principales manifestaciones cardiovasculares de esta enfermedad. Aunque en la era postantibiótica este tipo de manifestaciones tardías son cada vez menos frecuentes, es imperativo conocerlas.

Abstract Syphilis is a bacterial infection caused by Treponema pallidum (spirochete). It has various stages: primary, secondary and tertiary; depending on the time to progression from the moment the infection is acquired. Each stage involves various clinical manifestations; cardiovascular symptoms are part of tertiary syphilis, and syphilitic aortitis is the main form of presentation. We present the case of a patient who consulted with a focal neurological deficit, in whom extension studies reported neurosyphilis and severe aortic failure secondary to perforation of the right coronary valve, which required aortic valve replacement by bioprosthesis. We also undertake a review of the main cardiovascular manifestations of this disease. Although in the post-antibiotic era this type of late manifestation is increasingly less frequent, it is imperative that we are aware of it.

Acute coronary syndrome of very unusual etiology.

Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40-year-old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac-computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.

Aneurisma aórtico sifilítico en la era antibiótica, una vieja enfermedad con nueva historia / Syphilitic aortic aneurysm in the antibiotic era, an old disease with a new history

Los aneurismas de la aorta abdominal se presentan en el 5% a 10% de hombres entre 65 a 79 años de edad; es una patología multicausal que finalmente destruye la túnica media y altera la conformación de las fibras de colágeno de la pared arterial. Entre las principales causas se cita la aterosclerosis, enfermedades hereditarias (como el síndrome de Marfán), patologías inflamatorias y con baja prevalencia a la acción de agentes infecciosos (Salmonella, estafilococo dorado, Mycobacterium tuberculosis y Treponema pallidum). Se presenta el caso de un paciente con aneurisma de origen sifilítico, considerado una rareza médica en países desarrollados. No existen reportes en el país sobre casos de sífilis terciaria cardiovascular. Se complementa con una revisión bibliográfica de la epidemiología, clínica, diagnóstico y manejo. (AU)

Abdominal aortic aneurysms occur in 5% to 10% of men between 65 and 79 years of age. It has a multicausal pathology that ultimately destroys the tunica media and alters the conformation of the collagen fibers of the arterial wall. The main causes include atherosclerosis, hereditary diseases (such as Marfan syndrome), inflammatory pathologies and low prevalence of infectious agents (Salmonella, staphylococcus, Mycobacterium tuberculosis and Treponema pallidum). We present the case of a patient with an aneurysm of syphilitic origin, considered a medical rarity in developed countries. There are no reports in the country on cases of cardiovascular tertiary syphilis. It is complemented with a scientific literature review of epidemiology, clinical diagnosis and management. (AU)