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C3 Syphilitic aortitis identified in a patient newly diagnosed with HIV – the emerging tip of an oncoming iceberg?
  1. Noel B Connolly1,
  2. Jonathan Shaw1,
  3. Cara Hendry2,
  4. Margaret Kingston1
  1. 1Manchester Centre for Sexual Health, The Hathersage Centre, Manchester Royal Infirmary, 280 Upper Brook Street, Manchester, UK
  2. 2Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester, UK

Abstract

Background A 38 year old man presented for HIV testing following his male partner’s diagnosis. Examination revealed systolic and decrescendo diastolic heart murmurs, palpable thrill, bounding pulses, and positive Corrigan’s sign. He had not tested previously for HIV or syphilis and had been in a monogamous relationship for 8 years. We describe this man who was asymptomatic – from both HIV and aortic valve disease – with incidental diagnosis of severe syphilitic aortitis following partner notification for HIV.

Results HIV antibody test was positive with baseline viral load 239505 copies/ml and CD4 count 103 cell/μL (8%). Syphilis serology was positive with rapid plasma reagin (RPR) 1:4. CXR was unremarkable. ECG was consistent with left ventricular hypertrophy with strain. Echo revealed severe mixed aortic valve disease, left ventricular hypertrophy, good LV systolic function and normal aortic arch appearance. He commenced prednisolone 60 mg OD for 5d, 72 hr before starting three weekly doses of 2.4 MU benzathine penicillin. He was admitted for 48 hr for cardiac monitoring at the start of treatment – which proceeded with no complication. Multidisciplinary involvement with GU physicians, cardiologists and cardiothoracic surgeons was instigated from the start with aortic valve ± root replacement planned imminently.

Discussion Resurgence of syphilis in the UK was reported in the late 1990s with an ongoing epidemic since, mainly involving MSM. Cardiovascular syphilis typically occurs 15–30 years following primary infection with Treponema pallidum, with complications in 10% of cases. Could this man be amongst the first cases to develop tertiary syphilis in this latest epidemic?

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