Case Presentation:

A 21–year–old male with no significant past medical history presents with two episodes of acute pericarditis in a one month period. The first episode was complicated by cardiac tamponade requiring pericardial drain. Work up during initial presentation (Table 1) revealed a large pericardial effusion with tamponade physiology and serologic studies that were unrevealing as to the underlying etiology. Patient remained asymptomatic for 4 weeks after his discharge, until his chest pain recurred and was readmitted with diagnosis of recurrent acute pericarditis. Review of symptoms obtained during this admission was notable for a resolved 0.5 cm nontender penile ulcer of two months duration. Exam revealed bilateral inguinal lymphadenopathy. Patient was found to have a positive RPR and was treated for early syphilis with Penicillin with no further relapses of pericarditis.

Discussion:

We present a case of a patient with recurrent pericarditis attributed to early syphilis. Syphilis has re–arisen worldwide. Cases of early syphilis detected in Colorado have increased almost 300% since 2007. Although known to affect almost every organ system, including the heart in tertiary syphilis, pericarditis is not a frequently recognized manifestation of the disease. There are only 3 case reports of syphilis pericarditis in the literature. In this case, the temporal relationship of symptoms and the resolution of them after treatment point to syphilis as the cause of the pericarditis.

Conclusions:

This case highlights the importance of a careful sexual history and review of symptoms in the diagnosis of syphilis, especially as new cases of syphilis are growing. Even today, syphilis remains “The Great Imitator”; Osler’s words ring true still, “the physician who knows syphilis knows medicine.”

Table 1Work up Results From Both Hospitalizations