NBME 21

nbme21/Block 4/Question#2

A 23-year-old woman comes to the student health ...

Obliterative endarteritis with lymphocytes and plasma cells

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submitted by liltr(0),

It is syphilis. Syphilis is an endarteritis! :)

“The pathologic changes associated with syphilis are characterized by obliterative endarteritis that is found in all stages of the disease.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811633/


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submitted by wasabilateral(0),

Syphilis pathogenesis is the inflammation and obliteration of the vasa vasorum (small blood vessels) that feeds bigger blood vessels like aorta, arteries, arterioles. It does not matter what the stage is, T. pallidum infects the vasa vasorum and, in the process, obliterates the nerves and blood vessels. This kills blood supply to those areas = ischemia but no pain (painless chancre). More localized in earlier stages, and in later stage, the spirochetes disseminate, so you have the aorta and spinal cord involvement but same pathogenesis. (Edit: Goljan explained this somewhere.)