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Jankowska L, Adamski Z, Polańska A, Bowszyc-Dmochowska M, Plagens-Rotman K, Merks P, Czarnecka-Operacz M, Żaba R. Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16992. [PMID: 36554872 PMCID: PMC9778711 DOI: 10.3390/ijerph192416992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Tertiary syphilis is a large diagnostic challenge. It is rarely the case that it affects the skin, bone tissue and the eyes at the same time. The presented case shows that extensive symptomatology of syphilis poses a challenge in making a proper diagnosis in patients whose history does not suspect STDs. The study aims to present the case of a young woman hospitalized with a suspected autoimmune disease, diagnosed with symptomatic late syphilis with involvement of the skin, bones and eyes.
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Affiliation(s)
- Lucyna Jankowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Katarzyna Plagens-Rotman
- Center for Pediatric, Adolescent Gynecology and Sexology Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
| | - Magdalena Czarnecka-Operacz
- Allergic and Occupational Skin Diseases Unit, Department of Dermatology, Medical University of Poznań, 60-355 Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Li Z, Cong X, Kong W. Matricellular proteins: Potential biomarkers and mechanistic factors in aortic aneurysms. J Mol Cell Cardiol 2022; 169:41-56. [DOI: 10.1016/j.yjmcc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/30/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
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Parillo M, Vaccarino F, Beomonte Zobel B, Quattrocchi CC. A Rare Case of Contained Chronic Rupture of Abdominal Aortic Aneurysm Associated With Vertebral Erosion: Pre- and Post-operative Findings on Computed Tomography and a Narrative Review. Vasc Endovascular Surg 2022; 56:15385744221108040. [PMID: 35688795 DOI: 10.1177/15385744221108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contained chronic rupture of aortic aneurysm (CCR-AA) is a rare condition that can be associated with vertebral body erosion (VBE) and is often a diagnostic challenge; in fact, CCR-AAs are in general hemodynamically stable and the patients tend to present with a non-specific low-back pain syndrome secondary to vertebral involvement. Furthermore, the differential diagnosis of a retroperitoneal mass can be difficult on medical imaging. We discuss the case of a 79-years-old man, heavy smoker without history of cardiovascular diseases, admitted to the emergency department with signs of left lower limb ischemia. The patient was hemodynamically stable and the medical examination revealed a pulsatile abdominal mass. Doppler ultrasound showed the presence of aneurysmal dilatation of infra-renal abdominal aorta and chronic femoropopliteal occlusion on the left side. The subsequent computed tomography angiography (CTA) demonstrated a voluminous retroperitoneal mass continuous with the infra-renal aorta, which infiltrated the psoas muscles and caused vertebral bodies erosion of the anterior wall in L2, L3 and L4 suspected for CCR-AA or mycotic aortic aneurysm. Furthermore, the examination confirmed the occlusion of the peripheral arterial circulation of the left lower limb. The patient underwent a successful open replacement of the infra-renal abdominal aorta through aorto-aortic prosthetic graft insertion; the visualization during the surgical procedure of a posterior vessel wall opening in continuity with the eroded vertebral bodies associated with negative microbiological culture of the thrombotic material sample, led to the definitive diagnosis of CCR-AA. The post-operative CTA showed successful open vascular treatment. A bypass surgery of the left lower limb was then performed with positioning saphenous graft between femoral common artery and posterior tibial artery. The patient was finally discharged in good clinical conditions.
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Affiliation(s)
- Marco Parillo
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Federica Vaccarino
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Bruno Beomonte Zobel
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, 220431Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Pesce A, Armocida D, Petrella G, Guerrini F, Pompucci A. Vertebral body erosion by a chronic contained rupture of thoraco-abdominal aortic aneurysm: systematic review and spine surgical recommendations. World Neurosurg 2021; 158:e75-e86. [PMID: 34737100 DOI: 10.1016/j.wneu.2021.10.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vertebral body erosion (VBE) is commonly caused by neoplastic, inflammatory or infectious diseases: it can be rarely associated with aortic wall disorders, such as contained rupture of aortic aneurysm (CCR-AA). CCR-AA is a rare event consisting of less than 5% of all reported cases. This condition is easily undiagnosed, differential diagnosis may be challenging, and there is no consensus or recommendation that dictates guidance on management of spinal surgical treatment. MATERIAL AND METHODS We performed a systematic review of literature of all cases of VBE secondary to CCR-AA to identify clinical, radiological, and surgical outcome characteristics with the aim of providing a basis for future research studies. RESULTS The search returned a total of 80 patients. All reported cases have a history of hypertension. In almost all cases the AA size reported was very high (mean diameter of 7.056 cm). The treatment of this condition involves various reported treatment strategies: a totally conservative approach, treatment of the aortic aneurysm through a minimally invasive endovascular procedure, or through open surgery and combined approach. Despite the wide variability in therapeutic strategy, the rate of good outcomes was 80%, relatively high. CONCLUSIONS ''Back pain'' and pain along the vertebral column are such frequent complaints that unusual etiologies or serious and life threatening complications may be overlooked. In addition to the common traumatic and degenerative causes of back pain, AA must also be considered. A combined approach between vascular and spine surgery could be achieved without any increased risk.
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Affiliation(s)
| | - Daniele Armocida
- Santa Maria Goretti Hospital, Latina (LT), Italy; Human Neurosciences Department Neurosurgery Division "Sapienza" University.
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Cocora M, Nechifor D, Lazar MA, Mornos A. Impending Aortic Rupture in a Patient with Syphilitic Aortitis. Vasc Health Risk Manag 2021; 17:255-258. [PMID: 34079272 PMCID: PMC8164716 DOI: 10.2147/vhrm.s289455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/03/2021] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 48-year-old man, admitted for atrial fibrillation with rapid heart rate and intense chest pain. A quick evaluation revealed a giant aortic aneurysm with severe aortic regurgitation and pericardial fluid without a trace of aortic dissection. Because of high suspicion of aortic rupture, an emergency surgery was planned, and a Bentall procedure was performed. On examination of the aortic wall revealing vertical wrinkling with a tree bark aspect, suspicion of syphilitic aortitis arose. The diagnosis was confirmed through postoperative serologic testing and histological examination. Histopathologic differential diagnosis, special treatment and follow-up are presented.
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Affiliation(s)
- Mioara Cocora
- Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Dan Nechifor
- Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Mihai-Andrei Lazar
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Aniko Mornos
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
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Bertoli MJ, Parikh K, Klyde D, Mazzola CA, Pandya Shah S. Spinal arteriovenous malformation in a pediatric patient with a history of congenital syphilis: a case report. BMC Pediatr 2021; 21:242. [PMID: 34011293 PMCID: PMC8132029 DOI: 10.1186/s12887-021-02707-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Spinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations. Case presentation A 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient’s paraplegia remained unchanged from preoperative presentation. Conclusion Congenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.
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Affiliation(s)
| | - Kruti Parikh
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David Klyde
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Catherine A Mazzola
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, NJ, USA
| | - Shridevi Pandya Shah
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA.
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Patelis N, Nana P, Spanos K, Tasoudis P, Brotis A, Bisdas T, Kouvelos G. The Association of Spondylitis and Aortic Aneurysm Disease. Ann Vasc Surg 2021; 76:555-564. [PMID: 33951524 DOI: 10.1016/j.avsg.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature. METHODS A systematic search was undertaken using MEDLINE, EMBASE and CENTRAL databases till May 2019, for articles reporting on patients suffering from spondylitis and aortic aneurysm. RESULTS The most involved aortic segment was infrarenal aorta (56.9%). The lumbar vertebrae were more frequently affected (79.7%). Commonest symptoms were back pain (79.1%), fever (33.7%) and lower limb pain (29.1%). 55.8% of cases were diagnosed using computed tomography. The pathology was attributed to infectious causes in 25.1% of cases. 53.4% of patients were treated only for the aneurysm, 27.9% for both pathologies, while two patients solely for the vertebral disease. Endovascular aneurysm repair was chosen in 12.8% of cases. The 30-day mortality was 8.1% (7/86); mostly from vascular complications. CONCLUSIONS A synchronous spondylitis and aortic aneurysm may share common etiopathology, when an infectious or inflammatory cause is presented. The lumbar vertebrae are more frequently affected. Low quality data do not allow safe conclusion to suggest the best treatment option.
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Affiliation(s)
- Nikolaos Patelis
- 3rd Department of Vascular Surgery, Athens Medical Center, Marousi, Greece
| | - Petroula Nana
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Konstantinos Spanos
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Panagiotis Tasoudis
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros Brotis
- Neurosurgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Theodosios Bisdas
- 3rd Department of Vascular Surgery, Athens Medical Center, Marousi, Greece
| | - George Kouvelos
- Department of Vascular Surgery, Larissa University Hospital, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Chaudhary F, Faghihimehr A, Subedi Y, Hodanazari SM, Yousaf MN. Syphilitic Aortic Aneurysm: A Rare Entity in the Era of Antibiotics. Cureus 2021; 13:e13647. [PMID: 33824800 PMCID: PMC8012739 DOI: 10.7759/cureus.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A thoracic aortic aneurysm is a rare entity of tertiary syphilis in the era of antibiotics. The diagnosis of the aortic aneurysm due to tertiary syphilis may be challenging due to deceptive clinical presentation and rarity of the disease in the western world. We report the case of a 59-year-old man, who presents with worsening shortness of breath and was found to have a large ascending aortic aneurysm on computed tomography angiogram (CTA) of the chest. Further workup demonstrated a positive syphilis test. Untreated earlier stages of syphilis attribute to the development of the ascending aortic aneurysm. The patient was medically treated with IV penicillin and underwent surgical repair of the aortic aneurysm. Histopathology confirmed the diagnosis of syphilitic aortitis. Tertiary syphilis often presents several years after initial infection and usually after a latent phase, making it difficult to diagnose. Syphilitic aortic aneurysms may result in a high mortality rate in untreated patients. Therefore, a high index of suspicion is required for the early recognition of a syphilitic aortic aneurysm. Early treatment with antibiotic therapy and surgical repair of syphilitic aortic aneurysms can prevent life-threatening complications.
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Affiliation(s)
- Fizah Chaudhary
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | | | - Yogesh Subedi
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
| | | | - Muhammad N Yousaf
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA.,Medicine, MedStar Franklin Square Medical Center, Baltimore, USA.,Medicine, MedStar Good Samaritan Hospital, Baltimore, USA.,Medicine, MedStar Harbor Hospital, Baltimore, USA
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Jana S, Hu M, Shen M, Kassiri Z. Extracellular matrix, regional heterogeneity of the aorta, and aortic aneurysm. Exp Mol Med 2019; 51:1-15. [PMID: 31857579 PMCID: PMC6923362 DOI: 10.1038/s12276-019-0286-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
Aortic aneurysm is an asymptomatic disease with dire outcomes if undiagnosed. Aortic aneurysm rupture is a significant cause of death worldwide. To date, surgical repair or endovascular repair (EVAR) is the only effective treatment for aortic aneurysm, as no pharmacological treatment has been found effective. Aortic aneurysm, a focal dilation of the aorta, can be formed in the thoracic (TAA) or the abdominal (AAA) region; however, our understanding as to what determines the site of aneurysm formation remains quite limited. The extracellular matrix (ECM) is the noncellular component of the aortic wall, that in addition to providing structural support, regulates bioavailability of an array of growth factors and cytokines, thereby influencing cell function and behavior that ultimately determine physiological or pathological remodeling of the aortic wall. Here, we provide an overview of the ECM proteins that have been reported to be involved in aortic aneurysm formation in humans or animal models, and the experimental models for TAA and AAA and the link to ECM manipulations. We also provide a comparative analysis, where data available, between TAA and AAA, and how aberrant ECM proteolysis versus disrupted synthesis may determine the site of aneurysm formation. A review of aneurysm formation, swelling in blood vessel, in the aorta, examines distinctions between two forms of the condition and the role of proteins in the extracellular matrix which surrounds cells of the arterial wall. Rupture of aneurysms in the aorta, the body’s main artery, is a major cause of death. Researchers led by Zamaneh Kassiri at the University of Alberta, Edmonton, Canada, emphasize that aneurysms in the thoracic and abdominal regions of the aorta are distinct conditions with crucial differences in their causes. Disrupted production and assembly of the extracellular matrix and its proteins may underlie thoracic aneurysm formation. Factors triggering the degradation of extracellular matrix proteins may be more significant in abdominal aneurysms. Understanding the differing molecular mechanisms involved could help address the current lack of effective drug treatments for these dangerous conditions.
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Affiliation(s)
- Sayantan Jana
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada
| | - Mei Hu
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada
| | - Mengcheng Shen
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Zamaneh Kassiri
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, AB, Canada.
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Abstract
The aim of this study was to outline the clinical features of syphilitic aortic aneurysm. The study materials were based on a comprehensive literature review of publications on syphilitic aortic aneurysm published between 2000 and 2017. Syphilitic aortic aneurysm occurred most commonly in the ascending aorta in either a saccular or a fusiform shape. Syphilitic aortic aneurysm was often complicated by aortic valve insufficiency (in almost half of the patients), and by a coronary artery/ostium lesion in 16.5% of the patients. Aortic valve operation was necessary in one fourth, and coronary artery surgery accounted for less than one fifth of patients warranting a surgical treatment. Although there was no difference in the survival rates between the surgically and conservatively treated patients, an aggressive treatment should be performed when diagnosis is made due to the potential risks of aneurysm rupture and sudden death.
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Affiliation(s)
- S-M Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, 351100, Putian, Fujian Province, China.
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