ArticleJACC. Case reports2025
Syphilitic Mitral Valve Endocarditis: Diagnostic Challenges and Clinical Management.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
backgroundSyphilis, caused by the bacterium Treponema pallidum, affects over 5 million people annually. Although rates have been declining, recent increases have been seen in men who have sex with men and in younger age groups. CASE SUMMARY: A 38-year-old man with polysubstance abuse presented with chest pain, dyspnea, and orthopnea after a viral prodrome. Laboratory tests showed elevated levels of troponin and B-type natriuretic peptide. Coronary angiogram was normal, and right heart catheterization indicated elevated filling pressures. An echocardiogram showed severe mitral and tricuspid regurgitation, along with a 1.5 × 1.0 cm vegetation on the mitral valve. Syphilis serologies were positive, and polymerase chain reaction analysis of valve tissue confirmed the presence of T pallidum. DISCUSSION: Untreated syphilis can progress to tertiary syphilis, causing syphilitic aortitis. Mitral valve endocarditis is rare. This case emphasizes the importance of considering syphilis in cases of culture-negative endocarditis. TAKE-HOME MESSAGE: Consider T pallidum infection in cases of culture-negative endocarditis.
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