Syphilitic Hepatitis: An Uncommon Manifestation

Abstract

Syphilis is a systemic disease caused by the transmission through sexual contact of Treponema pallidum. It has a high incidence in men who have sex with other men, and is associated with human immunodeficiency virus (HIV) infection. The diagnosis depends on serological tests or confirmation of the spirochete in histological samples. The primary lesion courses after a latency period of 2 to 6 weeks, and the secondary disseminated phase, usually associated with mucocutaneous lesions and lymphadenopathy, may involve any organ. Symptomatic syphilitic hepatitis is a rare manifestation, the diagnosis of which is a challenge. It is characterized by a marked elevation of alkaline phosphatase, moderate elevation of transaminases, and no bilirubin changes. Histologically, portal inflammation and non-caseous granulomas predominate without associated necrosis. The case described is a rare manifestation of secondary syphilis, in the form of hepatitis in a sexually active HIV-infected patient with good response to the recommended benzathine penicillin treatment.

When the Sailor’s Handshake Fails: A Case of Syphilitic Hepatitis in an HIV Patient With Nonspecific Liver Biopsy and Atypical Cutaneous Presentation

“…Rashes and dermatologic lesions are more often reported as painless and non-pruritic [ 1 - 4 , 8 , 9 ]. Sparse cases reported pruritic rashes but not subjective pain [ 4 , 10 ]. Interestingly, immunohistochemical staining of skin biopsies highlighted numerous spirochetes, further supporting the diagnosis of secondary syphilis (Figure 5 ).…”

“…Liver biopsy findings were variable when performed. Pruritic rashes were described by Baveja et al [7] and Cordoso et al [10].…”