Case study #3
A 36-year-old man presents to the clinic with complaints of a genital sore. The patient is a sexually active heterosexual involved with three partners and practices unprotected intercourse. Fours days ago he noted a painless sore on his penis. He is afebrile, with a heart rate of 80/min and blood pressure of 120/77 mm Hg. Physical examination reveals a solitary ulcerated lesion located on the lateral aspect of his penis. The lesion is nontender and associated with bilateral inguinal lymphadenopathy. Physical examination is otherwise normal. If left untreated, this man is at increased risk for which of the following? (A) Ascending aortic aneurysm (B) Coronary artery aneurysm (C) Endocarditis (D) Mitral valve stenosis (E) Rupture of ventricular free wall
He has got syphilis...if left untreated can cause ascending aortic aneurysm
The genital sore is Chancre of Syphilis. If the disease progresses it can lead to Ascending Aortic Aneurysm.
And the answer is... A, ascending aortic aneurysm! The patient presents with primary syphilis. The lesion is typically a single painless papule that rapidly becomes eroded and indurated. Chancres are usually located on the penis in heterosexual males but in homosexual males may be found in the anal canal, mouth, or external genitalia. In females they may be seen on the cervix or labia. Serology or dark field microscopy can be used to confi rm the diagnosis. If left untreated, the patient may progress to secondary and tertiary syphilis. Tertiary syphilis causes disruption of the vasa vasorum or the aorta and consequent dilation of the aorta, often involving the aortic root or ascending aorta. This can result in aneurysm of the ascending aorta and aortic valve incompetence. Answer B is incorrect. Coronary artery aneurysms are a sequela of Kawasakiâs disease. Answer C is incorrect. Complications of endocarditis include chordae rupture, glomerulonephrits, pericarditis, and distal emboli. Answer D is incorrect. Mitral valve stenosis is seen as a late sequelae of rheumatic heart disease. Answer E is incorrect. This complication may be seen 4â10 days after a myocardial infarction (MI). Congratulations to Kushal, Emergencymedfreak, Suci, Sampath, Shubham, Malarvizhi.
