Tertiary Syphilitic Aortitis Manifesting as Ascending Aortic Aneurysm and Dissection

BACKGROUND: Aortic dissection in tertiary syphilis is rare, typically precluded by the dense medial fibrosis characteristic of syphilitic aneurysms. CASE SUMMARY: A 42-year-old woman presented with dyspnea, weight loss, and syncope. Echocardiography revealed a large ascending aortic aneurysm associated with dissection and intramural hematoma, with severe aortic regurgitation and a tricuspid valve. Computed tomography confirmed the dissection. Serological screening was positive for both HIV and syphilis. The patient underwent surgical intervention, with a favorable clinical outcome. DISCUSSION: This case illustrates the resurgence of syphilis, a life-threatening cardiovascular complication. Progression to dissection represents an atypical clinical trajectory for syphilitic aortitis. The active inflammatory phase may paradoxically weaken the aortic wall and facilitating dissection. Syphilis prevalence is increasing worldwide, necessitating clinical vigilance. TAKE-HOME MESSAGE: The identification of an aortic aneurysm in young patients, particularly in the presence of a tricuspid aortic valve, should prompt immediate screening for syphilis and other infectious etiologies.