CARDIO-AORTIC INVOLVEMENT IN CONGENITAL SYPHILIS WITH CO-EXISTENT RHEUMATIC HEART DISEASE BY

A familiar and not uncommon clinical problem is provided when a patient presents with signs of aortic incompetence together with a history of rheumatic fever and a positive serological test for syphilis. The cause of the aortic valve lesion usually rests between syphilis and rheumatism, and the diagnosis will swing in one direction or the other according to the presence or absence of col-lateral signs of the respective diseases. If such a patient also shows unequivocal evidence of mitral stenosis, the cause of the combined lesions may reasonably be attributed to rheumatic heart disease. Likewise, the co-existence of an aneurysm of the thoracic aorta and aortic incompetence strongly suggests a comprehensive diagnosis of cardio-aortic syphilis. Occasionally, the possibility of combined syphilitic and rheumatic heart disease must be considered, albeit such a combination is uncommon. The essential features of the case to be described were aortic regurgitation, fusiform aneurysm of the ascending aorta and a persistently positive blood Wassermann reaction. A diagnostic exercise was set by the fact that the aortic valve lesion became manifest about two months after an attack of rheumatic fever, the aneurysm being detected for the first time 18 years later. Further, the patient was known to be a subject of congenital syphilis