A patient with acute syphilis may develop a septic cardiomyopathy.
Mechanism: mitochondrial damage and oxidative stress
Clinical features:
(1) presence of acute early syphilis (may not be known at the time of onset)
(2) onset of cardiac dysfunction
(3) usually reversible within 2 weeks
(4) exclusion of coronary artery disease or other cause
(5) variable multi-organ dysfunction
Echocardiographic features:
(1) left ventricular ejection fraction < 50%
(2) decreased left ventricular longitudinal strain
(3) increased left ventricular end-diastolic diameter
Laboratory markers:
(1) elevated serum troponin
(2) elevated serum NT-proBNP
(3) positive marker for syphilis
Differential diagnosis:
(1) Classic cardiovascular syphilis occurs 10-30 years after the acute infection.
(2) coronary artery disease
(3) cardiomyopathy due to other cause
