An uncommon presentation of a common disease: a case of tertiary syphilis

Thoracic aortic aneurysm is one of the late and uncommon presentations of syphilis. If the aneurysm is large it causes symptoms suggesting mass effect. Syphilis being a common disease worldwide has recently re-emerged. Early syphilis if left untreated can lead to a significant morbidity. We reported a case of 44 years old man who was incidentally detected to have syphilitic thoracic aortic aneurysm with features of SVC compression.

A rare and forgotten cause of aortic aneurysm: tertiary syphilis

Cardiovascular syphilis occurs 15 to 30 years after infection. Syphilitic aortitis is the most common manifestation and typically involves the ascending aorta. Aneurysm formation is the least common complication of aortitis; the majority of aneurysms are single and usually saccular. We report the images of a 51-year-old man with a history of chest pain that began one month before. An aneurysm of the ascending aorta was documented. The nontreponemal and treponemal tests were reactive. Other venereal diseases, as well as neurological involvement, were discarded. The patient received treatment for non-neurologic tertiary syphilis and surgical repair by the Bentall procedure with re-implantation of the coronary arteries. Pathology showed the aortic arterial layer displaying myxoid changes in the tunica intima, as well as inflammatory infiltrate. The vasa vasorum demonstrates inflammatory infiltration with lymphocytes and plasma cells. The previous findings support the diagnosis of syphilitic aortitis. The patient’s evolution was satisfactory with no current cardiovascular symptoms.

Acute paroxysmal cold haemoglobinuria; a case report and literature review

Paroxysmal cold hemoglobinuria (PCH) is a very rare subtype of autoimmune hemolytic anemia caused by the presence of cold-reacting autoantibodies in the blood and characterized by the sudden presence of hemoglobinuria, typically after exposure to cold temperatures. The acute onset PCH occurs following viral illnesses whilst the chronic form is secondary to hematological malignancies and tertiary syphilis. It is a complement mediated intravascular hemolytic anemia associated with a biphasic antibody against the P antigen on red cells. We describe a three year child who had acute onset PCH following likely viral infection. The diagnosis was confirmed by demonstration of strongly positive Donnath Landsteiner antibodies. She made a gradual recovery with supportive treatment, ten days following the initial detection of haemolysis. Parents were educated about the need to avoid cold exposure to prevent precipitation of further haemolysis and folic acid was commenced to assist the recovery of erythropoiesis. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.654-657

Micro-CT evaluation of historical human skulls presenting signs of syphilitic infection

Summary Background In tertiary syphilis, Treponema pallidum triggers the formation of granulomatous nodules in various organs of the human body. Within the skeleton, predominantly in the skull and long bones, these characteristic syphilitic lesions cause typical patterns of bone damage. In this study, micro-computed tomography (µ-CT) was used to assess the microarchitecture of these osseous defects in untreated syphilitic skull bones. Material and methods Bone structure of 30 macerated human skulls was noninvasively examined by means of µ-CT images (Viscom X8060 NDT). A total of 20 specimens showing typical morphological signs of syphilis were provided by the Collection of Anatomical Pathology of the Museum of Natural History in Vienna. They were compared to 10 macerated control skulls provided by the Division of Anatomy of the Medical University of Vienna. Results All samples affected by syphilis showed perforating defects and increased porosity. Furthermore, we observed sclerotic reorganization and complete loss of the cortical bone in 80% of infected cases. Cortical thinning occurred in 75%. Conclusion Our findings revealed extensive micromorphological bone destruction and a broad variability of osseous manifestations of (tertiary) syphilis.