Comment on Aortic Aneurysm: Dissection from the Root to Pelvis

Dear Editor, In January–March 2025 issue of the distinguished Journal of Medical Ultrasound, Jhang et al.[1] reported a rare case of aortic aneurysm (AA) in a Taiwanese woman with Marfan syndrome (MS). That case report importantly enriches the literature with MS-associated AA. However, we believe that Jhang et al.[1] ought to take into consideration an important factor contributing to the occurrence of AA before attributing the reported AA to the pathological consequences of MS. It is noteworthy that syphilis, a sexually transmitted disease, usually develops in different stages (primary, secondary, latent, and tertiary). Each stage has various clinical pictures and could last for many years. In the latent or tertiary stage, it is associated with numerous cardiovascular manifestations, such as aneurysm formation, valve regurgitation/or stenosis, and coronary vasculitis. Such advanced manifestations will develop when the diagnosis has not been established, and/or proper therapy has not been introduced in the early stage of the infection.[2] Histologically, syphilis triggers obliterative endarteritis of the small arteries of the vasa vasorum, escalating ischemic injury of the aortic media and consequent aneurysmal dilation.[3] Syphilis is a worrisome health problem in Taiwan. The available statistic showed that around 10 thousand syphilis confirmed cases were reported in 2023 across the country, up from about 9700 in the previous year.[4] Regrettably, Jhang et al.[1] did not consider the diagnostic panel for syphilis in the studied patient. If that panel was to unveil syphilis, the case in question could be surely regarded a novel case report in the literature of AA in a patient with concomitant MS and syphilis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.