Minami T, Nishikawa K, Suzuki S, Odaguchi H, Chino M
Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1994 Feb;42(2):302-5.
This case involved a 20-year-old male who on May, 14, 1992, lost consciousness while working and went into a state of shock. He was taken to a hospital, where cardiac tamponade was diagnosed. He was later transferred to this hospital. Based on the results of echocardiography, coronary arteriography and left ventriculography, a ruptured ventricular aneurysm was diagnosed. The patient underwent emergency surgery. Serologic tests for syphilis performed at admission were definitely positive. Histopathological examination of the wall of the ventricular aneurysm disclosed fibrous myocarditis and peripheral coronary endarteritis accompanied by infiltration of plasma cells and lymphocytes. Immunohistological study revealed treponeme in the histiocytes of the aneurysmal wall. The diagnosis was a ruptured ventricular aneurysm caused by syphilitic myocarditis. Since the advent of penicillin therapy, cardiovascular syphilis, particularly syphilitic myocarditis, has become a rare disease. The chief interest of this case is that treponeme was detected in the lesion of myocarditis.
该病例涉及一名20岁男性，1992年5月14日工作时失去意识并陷入休克状态。他被送往一家医院，在那里被诊断为心脏压塞。后来他被转至本院。根据超声心动图、冠状动脉造影和左心室造影结果，诊断为室壁瘤破裂。患者接受了急诊手术。入院时进行的梅毒血清学检测呈阳性。对室壁瘤壁进行组织病理学检查发现纤维性心肌炎和外周冠状动脉内膜炎，伴有浆细胞和淋巴细胞浸润。免疫组织学研究在瘤壁组织细胞中发现梅毒螺旋体。诊断为梅毒性心肌炎所致室壁瘤破裂。自从青霉素疗法问世以来，心血管梅毒，尤其是梅毒性心肌炎，已成为一种罕见疾病。本病例的主要关注点在于在心肌炎病变中检测到了梅毒螺旋体。
