Acute coronary syndrome of very unusual etiology.

Abstract

Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40-year-old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac-computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.

• Authors: Raimundo Barbosa-Barros, Andrés R Pérez-Riera, Kimmo Koivula, Jairo de Carvalho Santos, Luiz C de Abreu, Kjell Nikus
• Journal: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc (Ann Noninvasive Electrocardiol) Vol. 23 Issue 5 Pg. e12531 (09 2018) ISSN: 1542-474X [Electronic] United States
• PMID: 29356195 (Publication Type: Case Reports)
• Copyright: © 2018 Wiley Periodicals, Inc.

Chemical References

• Anti-Bacterial Agents
• Penicillins

Topics

• Acute Coronary Syndrome (diagnosis, drug therapy, etiology)
• Adult
• Anti-Bacterial Agents (therapeutic use)
• Coronary Angiography (methods)
• Coronary Artery Bypass
• Coronary Stenosis (diagnostic imaging, etiology, surgery)
• Electrocardiography (methods)
• Humans
• Male
• Penicillins (therapeutic use)
• Syphilis (complications, diagnosis, drug therapy)