Unusual Manifestations of Syphilitic Cardiovascular Disease

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Abstract
A 36-year-old man was hospitalized because of pain and swelling of the ankles, and fever. On examination aortic incompetence widening of the thoracic aorta, edema, and tenderness of the ankles and clubbing of the fingers and toes were found. Significant laboratory findings were an elevated sedimentation rate, anemia, and an inverse albumin: globulin ratio with up to 35% gamma globulins; pathological liver function tests; and positive serologic tests for rheumatoid arthritis and syphilis, including Nelson''s immobilization test. X-rays of the long bones showed periosteal new bone formation. Antibiotic treatment was instituted. However, the patient''s condition deteriorated rapidly; congestive heart failure, uremia, and jaundice developed. He died 10 days after rupture of the mitral chordae tendineae was diagnosed. Autopsy revealed aortic aneurysm, meso-aortitis, aortic incompetence, cardiomegaly, extensive myocardial scarring, and widespread myxomatous degeneration of the cardiovascular connective tissue. Vegetations were present on the mitral valve, the posterior chordae tendineae of which were ruptured. The lungs showed severe brown induration. The serous cavities contained effusions. The internal organs were congested. The glomerular capillary basement membranes were thickened. The psoas muscle exhibited marked myositic changes. The tibia showed hypertrophic osteoarthro-pathy and peripherally an amorphous, band-like, calcified mass. Apparently cardiac myxomatous degeneration, progressing to scar tissue formation, was a major cause of chronic heart failure and of rupture of the chordae tendineae. Cardiovascular myxomatous degeneration might represent a form of connective tissue damage due to a hypersensitivity reaction elicited by an antigen developing in the course of the syphilitic infection. The hypergammaglobulinemia, valvular vegetations, and the renal and muscular alterations support the view that such a reaction took place.