From the Guidelines
Yes, syphilis can cause large vessel vasculitis, specifically aortitis, which can lead to thoracic aortic aneurysms.
Key Points
- Syphilis, caused by the bacterium Treponema pallidum, can infect the aorta, leading to aortitis, which is a rare cause of thoracic aortic aneurysms 1.
- The ascending thoracic aorta is most often involved in syphilitic aortitis, and the aneurysm may not appear for 10 to 25 years after the initial infection 1.
- Aortitis associated with syphilis can cause destruction of the medial layers of the aortic wall, leading to weakening of the aortic wall and potentially resulting in aneurysm formation or rupture 1.
- Other causes of large vessel vasculitis include autoimmune diseases, such as Takayasu arteritis and giant cell arteritis, as well as infectious diseases like bacterial or fungal aortitis 1.
- The diagnosis and management of syphilitic aortitis require a comprehensive approach, including antibiotic treatment and monitoring for potential complications like aneurysm formation or rupture.
Relevant Mechanisms
- The infection can arise through contiguous spread from adjacent thoracic structures, septic emboli from underlying bacterial endocarditis, or hematogenous dissemination of bacteria in the setting of sepsis or intravenous drug abuse 1.
- The aortic wall can be affected by inflammatory lesions, smooth muscle and fibroblast necrosis, and fibrosis, leading to weakening of the aortic wall and increased risk of aneurysm formation or rupture 1.
From the Research
Syphilis and Large Vessel Vasculitis
- Syphilis is known to cause vasculitis, particularly in large elastic arteries, including the aorta and major proximal branches 2.
- Tertiary syphilis is listed as one of the diseases that can cause large-vessel vasculitis, along with Takayasu arteritis and giant cell arteritis 2.
- However, the relationship between syphilis and large vessel vasculitis is not fully understood, and more research is needed to determine the exact mechanisms and prevalence of this condition.
Studies on Syphilis and Vasculitis
- A study on small vessel occlusion and syphilis in patients with first-ever ischemic stroke found that syphilis was associated with small vessel disease, but did not specifically investigate large vessel vasculitis 3.
- Another study on endovascular treatment of large vessel arteritis did not mention syphilis as a cause of large vessel vasculitis, instead focusing on Takayasu arteritis and giant cell arteritis 4.
- A case series on large artery vasculopathy in HIV-positive patients found that only one patient had a positive test for syphilis, suggesting that syphilis may not be a common cause of large vessel vasculitis in this population 5.