{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:46:39Z","timestamp":1784641599498,"version":"3.55.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82070400"],"award-info":[{"award-number":["82070400"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270367"],"award-info":[{"award-number":["82270367"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    Cardiovascular syphilis, a late manifestation of\n                    <jats:italic>Treponema pallidum<\/jats:italic>\n                    infection, remains a diagnostic challenge, particularly when serological tests are discordant. We report a case of a 70-year-old male with recurrent chest tightness and discordant syphilis serology (non-reactive RPR, reactive TPPA). Coronary angiography revealed a critical stenosis at the distal left main coronary artery, specifically involving the ostio-proximal segment of the left anterior descending (LAD) artery. Critically, the absence of systemic atherosclerosis was evidenced by a coronary artery calcium score of zero and normal carotid intima-media thickness. Optical coherence tomography (OCT) provided definitive diagnostic clarity by revealing microstructural features pathognomonic for syphilitic vasculitis: vasa vasorum obliteration, elastic lamina fragmentation, and adventitial fibrosis with microcalcifications. These findings were distinct from atherosclerotic plaque. The patient successfully underwent OCT-guided percutaneous coronary intervention followed by targeted antibiotic therapy. This case highlights the indispensable role of OCT in establishing the etiology of non-atherosclerotic proximal coronary stenosis, underscoring that cardiovascular syphilis must be considered even with non-reactive non-treponemal tests in late-stage disease.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2025.1714726","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T05:10:37Z","timestamp":1762837837000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Syphilitic proximal coronary stenosis with discordant serology: diagnostic validation by optical coherence tomography"],"prefix":"10.3389","volume":"12","author":[{"given":"Jingjie","family":"Xiong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Gan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuehua","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxi","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ni","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanli","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianyi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihui","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaohui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1186\/s12879-023-08740-9","article-title":"Sero-prevalence 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