A Case of Syphilis Presenting with Initial Syphilitic Hepatitis and Serological Recurrence with Cerebrospinal Abnormality

Abstract

We present the case of an immunocompetent 50-year-old Japanese man with a cerebrospinal fluid (CSF) abnormality relevant to syphilis; his original presentation was liver dysfunction, the etiology of which was uncertain until positive serology for syphilis was identified. Liver dysfunction was promptly resolved after oral penicillin therapy; however, serological recurrence developed. CSF abnormality associated with syphilis was confirmed by subsequent lumbar puncture. Syphilis should be included in the differential diagnosis of patients with liver dysfunction of unknown etiology, and possible neurosyphilis should be considered when the treatment becomes refractory, even when there is no evidence of neurological manifestations.

The Great Impostor: Transaminitis Masking the Coinfection of Syphilis and Human Immunodeficiency Virus

“…In contrast, liver biopsy is another diagnostic modality, but it is underutilized due to its invasiveness and cost. We did not perform a liver biopsy; however, histologically syphilitic hepatitis causes infiltration of inflammatory cells in portal area, which cause intralobular bile duct degeneration leading to mild hepatitis and periportal hepatocyte necrosis [10]. Jung et al conducted a retrospective study, in which 100 out of 1,599 HIV patients were coinfected with syphilis [11].…”

Cutaneous and VisCeral syphilis: unusual presentation

“…A diagnosis criterion of syphilitic hepatitis should take into consideration the following: elevation of serum marker enzymes activities of liver damage and serological evidence of syphilis, associated with clinical manifestations suggestive of secondary syphilis; exclusion of other causes which may induce to liver damage; rapid recovery of hepatic function after introduction of antibiotic medication. The prognosis of syphilitic hepatitis is generally favourable, although there are rare cases of acute liver failure described in literature (9,13,14) .…”

Answer to June 2013 Photo Quiz

“…The diagnostic criteria for syphilitic hepatitis are abnormal liver enzymes indicating hepatic involvement, serologic evidence of syphilis in conjunction with acute clinical presentation consistent with primary or secondary syphilis, and exclusion of alternative causes of hepatic damage with prompt liver function recovery after antimicrobial therapy (1,2). This case met all the aforementioned criteria.…”