Syphilitic aortitis: chronic left coronary ostial occlusion and aortic regurgitation with aortitis

Before the discovery of penicillin, tertiary syphilis was the most common cause of thoracic aneurysms, but now cardiovascular syphilis is a clinical rarity in developed countries. We report a case of 69-year-old man who presented with sudden onset breathlessness that worsened insidiously for 2 months. Diagnosis of syphilitic aortitis was confirmed by laboratory findings, contrast computed tomography, echocardiography and coronary angiography. The patient underwent successful coronary artery bypass graft, aortic valve replacement and ascending aortic replacement. A high level of suspicion and awareness is needed for the diagnosis of the now rare disease.