title: Syphilitic aortitis and its complications in the modern era.
abstract: BACKGROUND
  Aortitis is a well-recognized manifestation of the tertiary stage of syphilis.
  
  
  METHODS
  Although often regarded as an unexpected diagnosis, actually new cases of cardiovascular syphilis continue to be reported. Presumably, Treponema pallidum invades the aortic wall and the inflammatory response progresses towards obliterative endarteritis and necrosis of the muscular and elastic fibers in the aortic media. The consequent weakening of the aortic wall can lead to severe complications, represented by aortic aneurysm, aortic valvular insufficiency, aortic root dilation and coronary ostial stenosis. We perused the literature of the last 6 years to assess the prevalence and possible changes over time of syphilis cardiovascular manifestations.
  
  
  RESULTS
  Forty four articles were collected, reporting on 66 patients. Many patients presented more than one complication. Aortic aneurysm was the most frequent involvement, detected in 71% of patients. Fusiform or saccular aneurysms often interested the thoracic aorta, primarily located on the ascending segment. The second most common complication was the aortic valvular insufficiency, found in 47% of patients. Coronary ostial stenosis and dilation of the aortic root were less frequent.
  
  
  CONCLUSIONS
  Comparing our study with the previous ones, the cardiovascular involvement appeared roughly constant over time. Although many articles fail to provide useful information, such as a detailed history and the presence of risk factors, we must note that most patients had no predisposing factors and denied a primary infection. Cardiovascular syphilis is still present nowadays and it is important not to forget the "great imitator" in the event of its characteristic symptoms.
authors.affiliation: Di.S.Sal. Section of Dermatology, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Drago
authors.affiliation: Di.S.Sal. Section of Dermatology, IRCCS AOU San Martino-IST, Genoa, Italy - giuliamerlo@hotmail.com.
authors.forename: Giulia
authors.initials: G
authors.lastname: Merlo
authors.affiliation: Di.S.Sal. Section of Dermatology, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Rebora
authors.affiliation: Di.S.Sal. Section of Dermatology, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Parodi
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D001014:Aortic Aneurysm / Q000209:etiology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D023921:Coronary Stenosis / Q000209:etiology; D006801:Humans; D013589:Syphilis, Cardiovascular / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*