Acute coronary syndrome of very unusual etiology

• Published in: Annals of noninvasive electrocardiology Vol. 23; no. 5; pp. e12531 - n/a
• Main Authors: Barbosa‐Barros, Raimundo, Pérez‐Riera, Andrés R., Koivula, Kimmo, Carvalho Santos, Jairo, Abreu, Luiz C., Nikus, Kjell
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.09.2018; John Wiley and Sons Inc
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - etiology; Acute coronary syndromes; Adult; Angina; Anti-Bacterial Agents - therapeutic use; Cardiovascular disease; Case Report; Case Reports; Computed tomography; Coronary Angiography - methods; Coronary artery; Coronary Artery Bypass; Coronary artery disease; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - etiology; Coronary Stenosis - surgery; Coronary vessels; EKG; Electrocardiography - methods; Etiology; Health risks; Heart diseases; Heart surgery; Humans; Laboratory tests; Lesions; Male; Mental depression; Patients; Penicillin; Penicillins - therapeutic use; Regurgitation; Risk analysis; Risk factors; Sexually transmitted diseases; STD; Stenosis; Surgery; Syphilis; Syphilis - complications; Syphilis - diagnosis; Syphilis - drug therapy; syphilitic aortitis; Thickening; coronary artery disease; syphilitic aortitis; acute coronary syndrome
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/anec.12531

Aortitis is one of many possible manifestations of tertiary syphilis. Aortic disease is the most common of all cardiovascular syphilitic lesions. Aortic diseases caused by tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation and coronary ostial stenosis. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 40‐year‐old male patient admitted with a clinical picture of acute coronary syndrome (unstable angina). He had no risk factors for coronary artery disease. The physical examination revealed nothing remarkable. The admission electrocardiogram (ECG) showed ST segment depression in the anterolateral and inferior leads (Figure 1). The coronary angiogram showed critical ostial stenosis of the right (RCA) and left main coronary artery (Figure 2a, b). Cardiac‐computed tomography showed aortic wall thickening with involvement of bilateral coronary ostia (Figure 2b, c). The patient was referred for coronary bypass surgery after treatment with two doses of penicillin G. The laboratory test was strongly positive for syphilitic infection. Postoperative treatment with benzathine penicillin, in doses recommended for tertiary syphilis, was implemented.