Left Main Coronary Artery Ostial Stenosis Caused by Syphilitic Aortitis Presenting With Syncope

A 51-year-old man with a history of antibiotic therapy for syphilis 1 month ago presented with syncope. Computed tomography revealed circumferential aortic wall thickening complicating severe stenosis of left main coronary ostium. Abnormalities in serologic and cerebrospinal fluid tests led to the diagnosis of syphilitic aortitis and neurosyphilis. Coronary angiography demonstrated the severe stenosis of left main coronary artery ostium, and cardiac magnetic resonance imaging showed subendocardial late gadolinium enhancement involving basal to mid anteroseptal wall of the left ventricle. He was successfully treated with coronary artery bypass grafting with bilateral internal thoracic artery grafts. The postoperative course was uneventful, with the computed tomography scan showing that all grafts were patent. He was discharged without any symptoms on the 10th postoperative day.