Combined aorta and kidney injury in a patient with late visceral syphilis

In recent years, the incidence of late and unspecified forms of syphilis has increased in Russia, and cases of late manifest neurosyphilis and cardiovascular syphilis have become more common. The article describes a rare, combined injury of internal organs in an HIV-negative 58-year-old male who had untreated syphilis for more than 10 years and had negative results of RPR and IgM-EIA, but positive TPHA (4+) and IgG-EIA (1:160). Late visceral syphilis in this patient was manifested by nephrotic syndrome, edema, and arterial hypertension. By pathomorphological and immunofluorescent examination of the renal tissue biopsy material, secondary focal segmental glomerulosclerosis was diagnosed. Syphilitic nephropathy in the patient was combined with asymptomatic ascending aortic aneurysm with a diameter of up to 58 mm and aortic valve insufficiency. The presence of these injuries was confirmed by echocardiography and computed tomography. The patient has received the preliminary therapy with doxycycline followed by two courses of aqueous penicillin in accordance with Russian clinical guidelines for syphilis treatment. Due to kidney damage, the patient has also received systemic therapy with prednisone and hemodialysis procedures. During treatment, a significant reduction in edema, normalization of blood pressure and improvement in kidney function were noted. Surgical treatment of syphilitic valvulitis and aortic aneurysm is being planned.