A CASE OF SYPHILITIC AORTIC DISSECTION R Panicker MD, S Acosta MD, C Clark MD, B Shaik MD, N Salagundla MD Department of Medicine, Louisiana State University Health Sciences Center, Lafayette, LA INTRODUCTION Aortic dissection is a rare complication of syphilis in the antibiotic era which makes diagnostic assumption even more difficult. CASE: A 46-year-oldWoman with hypertension, Crohn's disease, chronic hepatitis B and latent syphilis presented with complaints of acute onset left arm numbness, pain and weakness when walking her dog. She initially presented five days prior for a Crohn's exacerbation and was incidentally found to have positive syphilis antibody diagnosed as untreated latent syphilis of unknown duration. Infectious disease was consulted and recommended 2.4 million units benzathine penicillin G weekly for three weeks with first dose given. During her current presentation, she was significantly hypertensive with systolic pressures in the 220’s. Physical examination was significant for decreased distal pulses in the left upper extremity (LUE) and labs were only significant for mild leukocytosis. LUE arterial ultrasound showed distal subclavian versus proximal axillary artery thrombus with high bifurcation of the brachial artery and minimal distal ulnar artery flow. Computed tomography (CT) angiography of the LUE confirmed the findings. A heparin drip was initiated, and vascular surgery consulted. She underwent an open embolectomy of the left distal axillary artery. On postop day 1, CT angiography of thorax revealed filling defect within the distal descending aortic arch with early dissection suspected. The patient did not have any prior CT scans of the thorax. A transthoracic echocardiogram showed mild left ventricular hypertrophy and an ejection fraction of 60%. She was transferred to an outlying facility where she underwent thoracic endovascular aortic repair with stent placement successfully and was discharged on chronic anticoagulation. DISCUSSION: Reports of aortic dissection secondary to syphilis is uncommon in literature. In untreated syphilis, aortitis/aneurysm may manifest after 15-30 years from initial infection. This case highlights the potential complication of untreated syphilis and raises a question of whether we should consider ordering a CT thorax in patients with untreated syphilis of unknown duration.
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