Abstract Vasculitis. The clinical expression of each entity depends on the vascular damage, vessel type predominantly affected, the location of it and its severity. Hypersensitivity vasculitis is generally self-limiting, with involvement of skin usual exclusively related and after taking certain drugs or infections. The usual clinical palpable purpura is general and nonspecific symptoms. The most characteristic histological finding is a leukocytoclastic vasculitis accompanied by IgA immune deposits in the affected organs.
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Abstract Context: Syphilitic aortitis has been relegated to the category of rare cardiovascular disease or a "medical curiosity" in the west. The same situation may not exist in developing countries due to the stigmata that continue to remain attached to sexually-transmitted diseases in general.
Aims: To study the prevalence of syphilitic aortitis among autopsied non-atherosclerotic aortic diseases encountered in a span of 15 years. Settings and Design: Retrospective, autopsy-based study.
Materials and Methods: Among cases of non-atherosclerotic diseases of the aorta, 44 had been diagnosed as syphilitic aortitis on the basis of the pathological features and serology. The demographic details and modes of clinical presentation were retrieved from the health records. Depending on the presence of complicating lesions, the cases were classified as uncomplicated or complicated aortitis.
Results: The 44 cases of syphilitic aortitis formed They were predominantly seen in males in the fifth decade, who often presented with valvular regurgitation, aneurysmal disease or myocardial ischemia; Blood VDRL results were available in 19 patients; Concomitant involvement of the ascending, transverse and descending thoracic was seen in None had uncomplicated aortitis. Complications in the form of aortic regurgitation Conclusions: We found syphilitic aortitis to be a common cause of aortitis at autopsy.
Diagnosis should be made with the help of characteristic pathological features correlated to the clinical context and appropriate serological tests. Syphilitic aortitis: Rearing of the ugly head. Involvement of the cardiovascular system is the most important sequel of the tertiary phase of syphilitic infection. This manifests usually as syphilitic aortitis and infrequently as gummatous myocarditis.
The advent of effective antibiotic therapy saw a pronounced decline in the incidence of late cardiovascular syphilis and hence in the west, syphilitic aortitis has been relegated to the category of rare cardiovascular disease or a "medical curiosity". Materials and Methods Review of the autopsy records at our hospital in a year-period yielded cases of non-atherosclerotic diseases of the aorta. Forty-four of these had been diagnosed as syphilitic aortitis.
In all cases, the demographic details and modes of clinical presentation of the patients were noted. All hearts were cut following the flow of blood and weighed after removing all the adherent post-mortem blood clots. Since this appearance is mimicked by a variety of inflammatory aortic diseases, we also relied on blood serology and the presence of chronic mesaortitis medial scarring, perivascular lympho-plasmacytic infiltrate, and endarteritis obliterans - [Figure 1] for the diagnosis.
Sections were taken from the various aortic segments and stained by hematoxylin-eosin and elastic van Geison stains. Depending on the presence of complicating lesions such as aortic regurgitation AR , coronary ostial stenosis COS and aneurysm formation, the cases were classified as uncomplicated or complicated aortitis.
Figure 1 : a Classic tree-barking, multiple gelatinous plaques, separated by stellate scars and vertical furrows, seen in the ascending aorta and arch. The arrow points at the perivascular inflammatory infiltrate rich in plasma cells.
Saccular aneurysm caused by bacterial endocarditis in a syphilitic aorta