Secondarily infected syphilitic aortic arch aneurysm in a patient on chronic renal dialysis with fatal haemoptysis

Abstract

This paper reports a case study of a 45-year-old man with known chronic renal failure requiring haemodialysis, hypertension and ischaemic heart disease, who presented with a three-week history of dyspnoea, orthopnoea and a productive cough. He developed sudden onset chest pain and haemoptysis without associated back pain. He was treated for pneumonia and Staphylococcus aureus sepsis, which was confrmed with two separate blood cultures. Chest radiography revealed a widened mediastinum. Computed tomography of the chest confrmed a saccular aortic arch aneurysm. Serodiagnostic tests for syphilis were positive. The patient consequently died due to massive haemoptysis. Postmortem investigation showed a ruptured aortic arch aneurysm, surrounded by a large haematoma, bulging into the patient's left lung. The case reported here should serve as a reminder of the importance of adequate treatment of primary syphilis in order to reduce the incidence of tertiary syphilis often associated with grave complications.