Genitourin Med 1987;63:277-8 Aortic regurgitation due to syphilis: unusual case

SUMMARY A 28 year old man developed signs and symptoms of left ventricular failure and was found to have gross aortic regurgitation. He underwent an aortic valve replacement, and histology showed changes characteristic of syphilis. Both the age of this patient and the mode of presentation were atypical of cardiovascular syphilis. Case report A 28 year old heterosexual storekeeper of Portuguese Indian extraction presented with a two week history of cough and progressive shortness of breath, the onset of which coincided with a febrile illness. His appetite had decreased and he had lost over three kilograms in weight. His only ever sexual contacts had been with a prostitute in Goa two years pre-viously and two prostitutes in Kenya 10 years pre-viously. There had been no history of sexual abuse as a child, but 10 years previously he had been tattooed on his forearm. Physical examination showed evidence of left ven-tricular failure, cardiomegaly, and the characteristic murmur of aortic regurgitation. Chest radiography, electrocardiography and echocardiography confirmed these findings. His blood pressure was 130/40mm Hg. The patient responded to conventional treatment for heart failure, and cardiac catheterisation showed severe aortic regurgitation. Serology showed positive results to the Treponema pallidum haemagglutination assay (TPHA) and the Venereal Disease Research Laboratory (VDRL) test at a titre of 1/256, the eryth-rocyte sedimentation rate was 47mm in the first hour, and the white cell count was 12-2 x 106/1. Treatment was started with prednisolone for 48 hours followed by procaine penicillin 600 mg and probenecid 500mg every six hours. An aortic valve replacement was performed, and at operation there was pronounced mediastinal oedema and tense serous pericardial effusion. A size 25 Medtronic-Hall tilting disc prosthesis was inserted