Rare Case of Tertiary Syphilitic Aortitis

Tertiary syphilis and its cardiovascular complications have become rare in developed countries but still remain a concern in our countries. Cardiovascular damage frequently involves the aortic root and arch. We report here a case of syphilitic aortic insufficiency in a 63-year-old female patient admitted to the cardiology department of the University Hospital of Casablanca. The clinical examination revealed stage II-III congestive heart failure, a quivering and diastolic murmur of significant aortic insufficiency confirmed by Doppler echocardiography, associated with anginal precordial pain. The skin examination showed syphilitic gum-like lesions with multiple locations. The electrocardiogram showed left ventricular hypertrophy with a Sokolov index of 44 millimeters and the frontal chest X-ray showed cardiomegaly with a cardiothoracic index of 0.65. The TPHA-VDRL serology was positive. The clinical evolution under monitored penicillin therapy and specific treatment of heart failure was unfavorable. The discovery of aortic insufficiency in subjects over 60 years of age in our countries should lead to a search for tertiary syphilis by serology for adequate management