Syphilitic aortitis as a rare cause of coronary ostial stenosis

Abstract

To the Editor, This is the case of a 62-year-old man who presented to the emergency department with signs of an acute neurological syndrome. He remained under regular monitorization due to spastic paraparesis. The patient’s past medical history also included dyslipidemia, active smoking, former alcohol abuse, and psoriasis. His routine medication included daily aspirin 150 mg, and simvastatin 20 mg. Due to severe worsening of his neurological status, he was admitted for further evaluation. After careful clinical evaluation, diagnosis of cerebellar and pyramidal syndrome in the neurosyphilis setting was achieved. Penicillin was started. During hospitalization, cerebral magnetic resonance imaging revealed the presence of a massive hernia at C4-C5 causing significant spinal cord compression. Decompressive surgery was advised. During hospitalization, he complained of chest pain. The ECG showed signs of sinus rhythm with sustained diffuse ST-segment depression and ST-segment elevation in aVR and V1. The transthoracic echocardiography showed a severely impaired left ventricular ejection fraction with severe hypokinesia of the apex, anterior, posterior, and lateral walls. The aortic root was mildly enlarged, but no flaps were seen. Due to refractory chest pain and progressively worsening hypotension, the patient was given unfractionated heparin (5000 IU) and underwent an emergency coronary angiography that revealed...