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A middle-aged patient was admitted to the hospital for surgical repair of an aortic aneurysm ( figure 1 A). As part of routine preoperative testing, performed especially in patients with aortic aneurysms, the patient tested positive for late syphilis. The patient denied having had any previous therapy for syphilis. The patient was therefore suspected of suffering from cardiovascular syphilis presenting clinically with an aortic aneurysm. Neurosyphilis was excluded.
The patient then underwent surgery ( figure 1 B) and was treated with doxycycline 100 mg per orally two times a day for 30 days because of a known penicillin allergy.
The histopathological examinations of the aortic aneurysm showed a degeneration of the elastic fibres as well as mucoid degenerations ( figure 2 ). The vasa vasorum were surrounded by dense lymphoplasmocellular infiltrates ( figure 3) . These results were consistent with mesaortitis luetic. The treponema immunostain did not detect any spirochaetes; however, this is not unusual in cardiovascular syphilis as...