Syphilitic hepatitis: Case report of an overlooked condition

Abstract

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractSyphilis is an overlooked cause of hepatitis. Syphilitic hepatitis should be a differential diagnosis in all patients with abnormal liver biochemical marker levels. Syphilitic hepatitis has been defined as the combination of increased liver enzymes, positive serology for syphilis, the absence of alternative causes for hepatobiliary injury, and liver enzyme improvement with proper antibiotic therapy. K E Y W O R D S Syphilis, Syphilitic hepatitis, Treponema pallidumHow to cite this article: Marcos P, Eliseu L, Henrique M, Vasconcelos H. Syphilitic hepatitis: Case report of an overlooked condition. Clin Case Rep.

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

“…These early observations are reflected in the criteria outlined by Mullick et al in 2004 [ 3 ]: (1) abnormal liver function tests (LFTs); (2) positive syphilis serologies (RPR and fluorescent treponemal antibody absorption [FTA-Abs] or microhemagglutination assay for Treponema pallidum antibodies [MHA-TP]); (3) evidence to rule out other etiologies of hepatic injury and (4) clinical improvement of LFTs following initiation of pharmacologic therapy. Liver function tests often present a cholestatic pattern more often than hepatocellular, notably with significant elevation in ALP [ 2 , 3 , 6 ]. However, patients can present with variable liver function tests and physical presentations, further challenging diagnosis and requiring a high index of suspicion (Table 1 ).…”

“…Our patient met previously outlined criteria by combining serological evidence of hepatic injury, infection with syphilis, exclusion of alternate etiologies, and response to treatment. A biopsy is not required to confirm the diagnosis of syphilitic hepatitis, especially with a positive response to treatment, because cellular changes are variable, and spirochetes may not be visible [ 2 , 3 , 6 ]. Liver biopsy for our patient was suggestive of mixed inflammation with patchy necrosis and negative for granulomas and spirochetes (Figure 2 ).…”

“…Spirochete dissemination has variable systemic manifestations, including hepatic, gastrocolic, renal, and dermatologic injury [ 1 ]. Inflammatory response to spirochetes may be responsible for pathology, as evidenced by lesion histopathology displaying various inflammatory infiltrates [ 2 ]. The degree of injury and clinical presentation may be influenced by individual immune-responsiveness, specifically augmented responses in HIV patients [ 3 ].…”

A Case of Syphilitic Hepatitis in an Adolescent

“…There are 3 described cases of syphilitic hepatitis in adolescents patients younger than 18 years of age (7)(8)(9). Hepatic involvement of syphilis can occur at any stage of the disease, although most commonly in early syphilis with nonspecific symptoms, necessitating high index of suspicion for diagnosis (1,2).…”

Acute Hepatitis as a Presenting Feature of Secondary Syphilis

“…However, our case highlights the rare possibility of encountering elevated aspartate transaminase and alanine aminotransferase levels in a case of syphilitic hepatitis. 5 Syphilis, although non-hepatotropic, may lead to unidentifi ed hepatitis, which can be diagnosed on the basis of characteristic liver enzyme patterns in the absence of other causes and seropositivity for syphilis. 6,7 Response to penicillin can also be regarded as a diagnostic criteria for syphilitic hepatitis.…”