梅毒二尖瓣心内膜炎：诊断挑战和临床管理。

Q4 Medicine

JACC. Case reports Pub Date : 2025-09-10 DOI:10.1016/j.jaccas.2025.104917

Roshan Bista MD , Mohamed Zghouzi MD , Victoria Odeleye MD , Caroline Eskind MD , Forrest Busler MD , Amber M. Edwards MD , Evelio Rodriguez MD , Andrew R. Sager MD , Paul W. McMullan MD , Timir K. Paul MD, PhD

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引用次数: 0

摘要

背景：梅毒由梅毒螺旋体引起，每年影响超过500万人。尽管发病率一直在下降，但最近在男男性行为者和年轻年龄组中出现了上升。病例总结：一名38岁男性滥用多种药物，在病毒性前体症状后表现为胸痛、呼吸困难和直立呼吸。实验室检查显示肌钙蛋白和b型利钠肽水平升高。冠状动脉造影正常，右心导管检查显示充盈压力升高。超声心动图显示严重的二尖瓣和三尖瓣反流，二尖瓣上有1.5 × 1.0 cm的赘生物。梅毒血清学阳性，瓣膜组织聚合酶链反应分析证实梅毒T的存在。讨论：未经治疗的梅毒可发展为三期梅毒，引起梅毒性大动脉炎。二尖瓣心内膜炎很少见。本病例强调了在培养阴性心内膜炎病例中考虑梅毒的重要性。关键信息：在培养阴性的心内膜炎病例中考虑苍白体感染。

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Syphilitic Mitral Valve Endocarditis

Background

Syphilis, 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.