Syphilis can present in a wide variety of ways, earning its reputation as “the great imitator”. In a minority of cases, the bacteria can invade the central nervous system and produce meningovascular syphilis, an inflammatory vasculopathy that can mimic neurovascular disease by manifesting as an ischemic stroke. Consideration and timely recognition of this manifestation of syphilis infection is paramount because if left untreated treponemal induced arteritis can progress, keeping patients at increased risk for additional strokes. We report the case of a 36-year-old man whose untreated HIV placed him at increased risk for the development of meningovascular syphilis. We also describe the use of an acceptable alternative therapy after the patient developed an allergic reaction to penicillin during treatment. This case highlights the importance of maintaining a high level of suspicion for infectious etiologies in patients presenting with stroke-like symptoms without conventional risk factors for neurovascular disease. In this case, such suspicion enabled a timely diagnosis and treatment, preventing further complications of untreated syphilis.

Background: Sex-related differences are well recognized in heart failure with preserved ejection fraction (HFpEF), but real-world data describing clinical outcomes by sex among patients with obesity and HFpEF treated with tirzepatide remain limited. Objectives: To compare observed hospitalization, cardiovascular, and gastrointestinal outcomes between male and female patients with obesity and HFpEF treated with tirzepatide. Design: Retrospective, propensity score-matched, within-treatment cohort study. Methods: A retrospective study was conducted using TriNetX database which included 110 healthcare organizations. Adults with obesity, HFpEF, and taking tirzepatide between June 1, 2022 and January 1, 2025 were identified. Males and females were balanced using 1:1 propensity score matching (n=1,654 per group). Primary outcome assessed included all-cause hospitalization. Secondary outcomes were all-cause mortality, HF exacerbation, major adverse cardiovascular events (MACE), incident atrial fibrillation, nausea/vomiting and diarrhea. Two prespecified falsification endpoints were used. Results: During 1-year follow-up, males had a lower hazard of all-cause hospitalization compared with females (HR 0.87, 95% CI 0.77–0.98). No significant differences were observed for all-cause mortality (HR 1.73, 95% CI 0.95–3.18), HF exacerbation (HR 1.14, 95% CI 0.90–1.44), MACE (HR 1.28, 95% CI 0.99–1.65), or incident atrial fibrillation (HR 1.21, 95% CI 0.61–2.43). Males experienced lower rates of nausea and vomiting (HR 0.50, 95% CI 0.37–0.67), while diarrhea was similar (HR 0.84, 95% CI 0.59–1.19). Falsification endpoints showed no significant associations. Conclusion: Among tirzepatide-treated patients with obesity and HFpEF, no statistically significant sex-associated differences were detected in major cardiovascular outcomes. Males had a modestly lower observed hazard of hospitalization and fewer coded nausea and vomiting events. Because this was a within-treatment observational comparison without an external comparator, these findings should not be interpreted as evidence of differential tirzepatide effectiveness by sex.

Background: Catheter ablation is an established rhythm-control strategy for atrial fibrillation, yet the optimal timing of ablation in older patients with heart failure with reduced ejection fraction remains uncertain. Methods: We conducted a retrospective study using the TriNetX research network, including adults aged ≥ 60 years with atrial fibrillation and systolic heart failure who underwent catheter ablation between 2010 and 2022. Patients were classified by the timing of catheter ablation relative to cardiac diagnosis, with early ablation defined as occurring within 1 year and delayed ablation defined as occurring after 1 year. Propensity score matching (1:1) across 24 covariates was performed to balance demographics, comorbidities, medications, and baseline clinical characteristics. Outcomes assessed from 90 days blanking period to 3 years post-ablation included atrial fibrillation recurrence, heart failure exacerbation events, and all-cause hospitalization using risk, survival, and incidence analyses. Results: After matching, 678 patients were included in each cohort with well-balanced baseline characteristics. Atrial fibrillation recurrence did not differ significantly between early and delayed ablation groups (hazard ratio [HR] 0.71, 95% CI 0.39–1.28). In contrast, delayed ablation (>1 year) was associated with a significantly higher risk of heart failure events (HR 0.62, 95% CI 0.54–0.70) and shorter median heart failure-free survival compared with early ablation. All-cause hospitalization risk was similar between groups, although time-to-event analyses favored ablation within 1 year (HR 0.71, 95% CI 0.59–0.85). Conclusions: In this large, real-world cohort of older patients with atrial fibrillation and systolic heart failure, late ablation was associated with worse 3-years heart failure outcomes and delayed hospitalization-free survival, despite similar atrial fibrillation recurrence rates. These findings suggest that ablation timing may differentially influence heart failure progression independent of rhythm recurrence and highlight the need for prospective studies to define patient-specific timing strategies in elderly populations.