A Patient with Early Syphilis Complicated by Fatty Liver Who Showed an Alleviation of Hepatopathy Accompanied by Jaundice after Receiving Anti-syphilitic Therapy

Ishikawa, Masatoshi; Shimizu, Ichiro; Uehara, Kohzou; Fujiwara, Soichiro; Shiraishi, Tatsuhiko; Yamamoto, Hirofumi; Horie, Takahiro; Iuchi, Arata; Ito, Susumu

doi:10.2169/internalmedicine.45.1746

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…Syphilitic hepatitis has been reported to be reversible in the majority of reported cases among non-HIV-infected patients. 11–13 The present study suggests that syphilitic hepatitis in HIV-infected patients diagnosed in early stages of infection may have similar prognosis as all cases resolved after treatment of syphilis. Raised LFTs returned to their reference range within a median of 16 weeks after treatment of syphilis.…”

Section: Discussionsupporting

confidence: 52%

Prevalence of hepatitis in early syphilis among an HIV cohort

2012

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To investigate the prevalence of syphilitic hepatitis among a group of HIV-infected patients we performed a cross-sectional observational study of consecutive HIV-infected patients with early syphilis attending University Hospital Birmingham between 1 January 2005 and 31 August 2008. The AIDS Clinical Trials Group grading for abnormal liver enzymes was used to identify hepatitis. A total of 62 HIV-infected patients were diagnosed with early syphilis during the study period. Twelve (19.3%) of them demonstrated abnormal liver enzymes consistent with syphilitic hepatitis involving raised levels of alanine aminotransferase, aspartate transaminase, alkaline phosphatase or gamma-glutamyl transferase (GGT). Grade 3 hepatotoxicity was observed among five patients. None of the patients with syphilitic hepatitis had grade IV hepatitis or abnormal bilirubin levels. Liver biopsy was not carried out in any of the patients, and following completion of treatment of syphilis all abnormal liver enzymes returned to normal levels after a median of 16 weeks. Exclusion of syphilis must be considered when investigating hepatic disease in HIV-infected patients.

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Section: Discussionsupporting

confidence: 52%

Prevalence of hepatitis in early syphilis among an HIV cohort

2012

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“…The elevation of the alkaline phosphatase is likely due to pericholangiolar inflammation 10,18. Cases also may present with elevated AST and ALT levels;6,19 while no case in our series had an elevated total bilirubin level, jaundice has been previously reported 20,21. Laboratory studies may also reveal renal involvement, most often seen as isolated proteinuria 22–24…”

Section: Discussionmentioning

confidence: 49%

“…10,18 Cases may also present with elevated AST and ALT levels; 6,19 while no case in our series had an elevated total bilirubin level, jaundice has been previously reported. 20,21 Laboratory studies may also reveal renal involvement, most often seen as isolated proteinuria. 22 -24 The most common clinical finding among HIV-infected patients with syphilitic hepatitis was the rash of secondary syphilis.…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of syphilitic hepatitis has been previously described as treponemal infiltration into periportal areas with an inflammatory response; 8,29 whether this could be intensified by pre-existing liver disease is unknown. 21 Further studies are needed to confirm the potential association between syphilitic hepatitis and HIV duration and to describe the nature of this relationship.…”

Section: Discussionmentioning

confidence: 99%

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Syphilitic hepatitis among HIV-infected patients

2009

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Summary Syphilis is an important public health issue which continues to occur at high rates among HIV-infected patients. Although abnormal liver function tests are common among HIV-infected persons, the incidence of syphilitic hepatitis in this population is currently unknown. We present two cases of syphilitic hepatitis and performed a retrospective study to determine the incidence of hepatitis during early syphilis infections among HIV-infected persons. Our study showed that syphilitic hepatitis is common occurring in 38% (12/32) of HIV-positive patients with early stages of syphilis infection. Most cases occurred during secondary syphilis with the most common finding being a maculopapular rash. Syphilis should be included in the differential diagnosis of HIV patients presenting with liver test abnormalities, rash and/or sexual risk factors.

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“…We attributed the modest rise in liver enzymes to hepatosteatosis, likely worsened by the metabolic and inflammatory derangement. However, it is good practice, when there is an increase in transaminases or cholestasis indexes in the absence of hepatitis or hepatobiliary disease, to carry out screening tests for syphilis, given that various degrees of hepatobiliary involvement are reported in early and late stages of syphilis 9,10 . An attempt to correctly define the patient's phenotype, even in the presence of an atypical presentation of the disease (Figure 2), is of particular relevance in a perspective of prevention and early treatment aiming at reducing severe complications and improving the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Syphilis iridocyclitis in a patient with type 1 diabetes

Comassi

Natali

Solini

2015

J of Diabetes Invest

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We present a rare cause of iridocyclitis in a patient with vitiligo and type 1 diabetes who showed poor metabolic control, and suffered from remitting fever, weight loss, fatigue, diffuse arthralgias and reduced visual acuity. Mild systemic symptoms coupled with increased cholestasis enzymes, insulin resistance, mild inflammation and a functioning adrenal gland focused our clinical work‐up on granulomatous causes of iridocyclitis. Specific tests confirmed syphilis, with no involvement of the central nervous system. Ocular syphilis, despite being unusual, can be the only manifestation of the disease. The work‐up of any unexplained ocular inflammation should include testing for syphilis so as to not delay the diagnosis.

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A Patient with Early Syphilis Complicated by Fatty Liver Who Showed an Alleviation of Hepatopathy Accompanied by Jaundice after Receiving Anti-syphilitic Therapy

Abstract: Abstract

Cited by 7 publications

References 6 publications

Prevalence of hepatitis in early syphilis among an HIV cohort

Prevalence of hepatitis in early syphilis among an HIV cohort

Syphilitic hepatitis among HIV-infected patients

Syphilis iridocyclitis in a patient with type 1 diabetes

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