Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection

Abstract Background Historically, tertiary syphilis infection has been the most common cause of thoracic aortic aneurysm, resulting in 5% to 10% of cardiovascular deaths until the era of antibiotics. Methods A 49-year-old Caucasian man presented to our institution with progressive dysphagia, weight loss, incomplete bladder emptying, alcohol and tobacco consumption, systemic arterial hypertension, Argyll Robertson pupil, leg paresthesias, and mediastinal widening. He was admitted to investigate clinical alterations. Thoracic computed tomography revealed an aortic aneurysm complicated with chronic aortic dissection from the ascending aorta to the iliac vessels with 2 communicating lumens. Cerebrospinal fluid examination tested positive for neurosyphilis in a venereal disease research laboratory test (titre 1/32). Results Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection was diagnosed. Conclusions This is a unique presentation of a syphilitic infection. Syphilitic aortitis, the hallmark of cardiovascular syphilis, has become rare and is hardly considered by today's clinicians in their differential diagnosis.