Syphilitic bicuspid aortic valve endocarditis diagnosed by metagenomic next-generation sequencing: a case report and literature review.

Authors

Zelei Ye, Yuxiang Liao, Zichen Gao, Shijia Chen, Qiaoqing Huang, Peifeng Jin

Published in

Frontiers in surgery. Volume 13. Pages 1911873. Epub Sep 28, 2026.

Abstract

Syphilitic endocarditis, a rare complication of tertiary syphilis, poses diagnostic challenges due to the unculturable nature of Treponema pallidum and non-specific clinical manifestations. This report highlights the role of quantitative metagenomic next-generation sequencing (Q-mNGS) in confirming the diagnosis.
A 52-year-old male patient with a bicuspid aortic valve presented with a cough and chest tightness. Serology confirmed syphilis, but blood cultures were negative. Transesophageal echocardiography revealed severe aortic regurgitation with vegetations. Q-mNGS of resected valve tissue detected T. pallidum despite negative Warthin-Starry staining. The patient underwent valve replacement and received penicillin G, with no recurrence at the 2-year follow-up.
Q-mNGS shows potentially higher sensitivity for diagnosing syphilitic endocarditis compared to traditional methods. Serological screening combined with molecular techniques is critical for culture-negative endocarditis in high-risk populations.

PMID:
42865488
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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