Zakia Douhi1*, Imane Couissi1, Hajar El Bennaye1, Hanane Baybay1, Fatima Zahra Mernissi1
1Department of Dermatology, University Hospital Hassan II, Morocco
*Correspondence author: Zakia Douhi, Department of Dermatology, University Hospital Hassan II, Fes, Morocco;
Email: [email protected]
Published Date: 24-04-2023
Copyright© 2023 by Douhi Z, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Flattened nose also called syphilis nose is a deformation of the nose due to the destruction of the cartilage of the nasal septum: the lower segment of the nose collapses, undergoes recoil and retract, becoming embedded in the upper segment. It is characteristic of congenital and tertiary syphilis. We report the case of syphilitic aortitis revealed by the flattened appearance of the nose.
Keywords: Flattened Nose; Tertiary Syphilis; Aortitis
Introduction
Syphilis, before the era of antibiotics, reigned among the leading causes of cardiovascular disease [1]. In its tertiary phase, it can be responsible for several vascular manifestations of varying severity. It occurs in 30% of patients not treated during the primary phase, symptomatic on 10 to 15% of cases [2]. We illustrate through this observation a case of syphilitic aortitis revealed by the flattened appearance of the nose.
Observation
A 45-year-old man, with no particular medical history, was seen in dermatological consultation for necrotic lesion on the lower limb. Clinic examination found necrotic plaques on the left leg and foot with bilateral edema and weak peripheral pulses (Fig. 1). The rest of the examination showed a collapse of the root of the nose (Fig. 2), not noted by the patient and not objectified in his old photos, giving the appearance of a lorgnette nose. Tertiary syphilis was suspected and confirmed by syphilitic serology (VDRL 1/16 TPHA > 2560). The evolution was marked by an extension of the lesions taking all the leg and the left foot, surmounted by place by hemorrhagic and meliceric crusts. The vascular examination found an abolition of the tibial and femoral pulses. An abdominal CT angiography was performed objectifying a chronic aorto bi-iliac occlusion (Fig. 3), for which he benefited from a trans-femoral amputation and was put on statin, antiplatelet, preventive anticoagulation and penicillin.
Figure 1: Necrotic plaques on the left leg and foot with bilateral edema.
Figure 2: Lorgnette nose.
Figure 3: Angiography aorto bi-iliac occlusion.
Discussion
Syphilis is a sexually transmitted and contagious infectious disease caused by Treponema pallidum. We distinguish currently recent syphilis grouping together primary-secondary syphilis and latent syphilis of less than one year for Anglo-Saxons or two years for Americans and late syphilis grouping together latent syphilis over a year or two years and syphilis tertiary [3]. Cutaneous manifestations of tertiary syphilis are diverse, dominated by gums, chronic ulcerations and tubercles. However, the most cited cardiovascular manifestations in the literature are: aortic aneurysm, aortic valvular insufficiency, aortic root dilatation and coronary ostial stenosis. Aortic occlusion has been rarely reported in the literature, but remains very noisy in terms of clinical.
Although often regarded as unexpected diagnosis, actually cases of cardiovascular syphilis continue to be reported. Presumably, Treponeme pallidum invades the aortic wall and the inflammatory response progresses towards obliterative endarteritis and necrosis of the muscular and the elastic fibers in the aortic media. The consequent is the weakness of the aortic wall, which can lead to severe complications [4].
Conclusion
Even in the absence of cardiovascular risk factors or primary infection, cardiovascular syphilis has to stay in mind, specially in young sexually active patients. It should not be forgotten the « great imitator » character of the syphilis.
Conflict of Interest
The authors have no conflict of interest to declare.
References
- A Mudry. Nose like the foot of a pot. Eur Ann Otorhinolaryngol Head Neck Dis. 2021;138(3):205-7.
- Jackman Jr JD, Radolf JD. Cardiovascular syphilis. Am J Med. 1989;87:425-33.
- Saraiva RS, Cesar CA, de Mello MAA, Bras R. Syphilitic aortitis: Diagnosis treatment. Case Report. Cir Cardiovasc. 2010;25:415-8.
- Drago F, Merlo G, Rebora A, Parodi A. Syphilitic aortitis and its complications in the modern era. G Ital Dermatol Venereol. 2018;153(5):698-706.
Article Type
Short Communication
Publication History
Received Date: 23-03-2023
Accepted Date: 18-04-2023
Published Date: 24-04-2023
Copyright© 2023 by Douhi Z, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Douhi Z, et al. Flattened Nose Revealing Syphilitic Aortitis. J Dermatol Res. 2023;4(1):1-3.
Figure 1: Necrotic plaques on the left leg and foot with bilateral edema.
Figure 2: Lorgnette nose.
Figure 3: Angiography aorto bi-iliac occlusion.
