S3168 Sinusoidal Obstruction Syndrome: A Known and Often Missed Complication of Oxaliplatin Therapy

Abstract

Infectious workup was pursued when the patient reported recent unprotected sex with male partners, and revealed negative HIV screen, positive IgM/IgG antibodies to both CMV and EBV, positive treponemal antibody, and RPR titer of 1:128. After one dose of Penicillin, the patient had resolution of his symptoms and lab abnormalities. Discussion: Hepatitis is a rare manifestation of syphilis, occurring in 0.2%-3% of patients with syphilis. 1 It is defined as abnormal liver enzyme levels with serological evidence of syphilis, exclusion of other causes of liver injury, and resolution of abnormal liver enzymes after treatment of syphilis. 2 Although liver involvement in syphilis can be observed at any stage of the disease, secondary syphilis is most common. 3 The clinical presentation of syphilitic hepatitis is nonspecific and usually involves rash and fatigue. Other symptoms are jaundice, fever, and abdominal pain. Lab tests usually show a marked elevation of serum ALP. 4 AMA antibodies, typically highly specific for PBC, can be positive due to molecular mimicry. 5 A diagnosis of syphilitic hepatitis is supported here by rapid resolution in symptoms and lab abnormalities after treatment with penicillin. Syphilis should be considered a cause of liver injury in patients with high-risk features, including unprotected sex with multiple partners. Early diagnosis and prompt treatment are important for preventing progression to late syphilis.