An Unusual Cause of Cholestatic Hepatitis: Syphilis

Aggarwal, Abhinav; Sharma, Vishal; Vaiphei, Kim; Duseja, Ajay; Chawla, Yogesh

doi:10.1007/s10620-013-2581-5

Cited by 6 publications

(14 citation statements)

References 10 publications

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“…Syphilis is potentially infectious in its early (primary, secondary, and early latent) stages. 1,5 The secondary stage generally begins 6 to 8 weeks after the primary infection 1 and presents with diverse symptoms, including arthralgia, condylomata lata, generalized lymphadenopathy, maculopapular and papulosquamous exanthema, myalgia, and pharyngitis. 1…”

Section: Infectious In Its Early Stagesmentioning

confidence: 99%

“…Liver dysfunction is common in secondary syphilis, occurring in 25% to 50% of cases. 5 The liver enzyme pattern in most cases is a disproportionate increase in the alkaline phosphatase level compared with modest elevations of aminotransferases and bilirubin. 2,5 However, some cases may show predominant hepatocellular damage (with prominent elevations in aminotransferase levels), and others may present with severe cholestasis (with prominent elevations in alkaline phosphatase and bilirubin) or even fulminant hepatic failure.…”

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

“…5 The liver enzyme pattern in most cases is a disproportionate increase in the alkaline phosphatase level compared with modest elevations of aminotransferases and bilirubin. 2,5 However, some cases may show predominant hepatocellular damage (with prominent elevations in aminotransferase levels), and others may present with severe cholestasis (with prominent elevations in alkaline phosphatase and bilirubin) or even fulminant hepatic failure. 2,5 The diagnostic criteria for syphilitic hepatitis are abnormal liver enzyme levels, serologic evidence of syphilis in conjunction with acute clinical presentation of secondary syphilis, exclusion of alternative causes of liver dysfunction, and prompt recovery of liver function after antimicrobial therapy.…”

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

“…2,5 However, some cases may show predominant hepatocellular damage (with prominent elevations in aminotransferase levels), and others may present with severe cholestasis (with prominent elevations in alkaline phosphatase and bilirubin) or even fulminant hepatic failure. 2,5 The diagnostic criteria for syphilitic hepatitis are abnormal liver enzyme levels, serologic evidence of syphilis in conjunction with acute clinical presentation of secondary syphilis, exclusion of alternative causes of liver dysfunction, and prompt recovery of liver function after antimicrobial therapy. 2,5 Pathogenic mechanisms in syphilitic hepatitis include direct portal venous inoculation and immune complex-mediated disease.…”

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

“…2,5 The diagnostic criteria for syphilitic hepatitis are abnormal liver enzyme levels, serologic evidence of syphilis in conjunction with acute clinical presentation of secondary syphilis, exclusion of alternative causes of liver dysfunction, and prompt recovery of liver function after antimicrobial therapy. 2,5 Pathogenic mechanisms in syphilitic hepatitis include direct portal venous inoculation and immune complex-mediated disease. 2 However, direct hepatotoxicity of the microorganism seems unlikely, as spirochetes are rarely detected in liver specimens.…”

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

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Palmoplantar exanthema and liver dysfunction

Fujikawa

Matsuura

2018

CCJM

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A 51-year-old man with type 2 diabetes was referred to our hospital because of liver dysfunction and nonpruritic exanthema, with papulosquamous, scaly, papular and macular lesions on his trunk and extremities, including his palms (Figure 1) and soles. Also noted were tiny grayish mucus patches on the oral mucosa. Axillary and inguinal superfi cial lymph nodes were palpable.Laboratory testing revealed elevated serum levels of markers of liver disease, ie: CLEVELAND

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Section: Infectious In Its Early Stagesmentioning

confidence: 99%

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

Section: Liver Dysfunction In Secondary Syphilismentioning

confidence: 99%

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Palmoplantar exanthema and liver dysfunction

Fujikawa

Matsuura

2018

CCJM

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Drug-induced cholestatic liver diseases

Bjornsson,

Devarbhavi

2024

Hepatology

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Cholestatic drug-induced liver injury is an important and frequently challenging differential diagnosis in patients presenting with elevated liver tests with predominant elevation in alkaline phosphatase (ALP). A number of competing etiologies need to be ruled out, such as hepatobilary malignancy, choledocholithiasis, cholestatic forms of viral hepatitis, cholestasis of sepsis, primary and secondary cholangitis and right sided cardiac failure to name a few. Important advances have occurred in the understanding and knowledge of the clinical phenotypes, new etiological agents, risk factors, pathophysiology and genetic determinants of drug-induced cholestasis since the last review on drug-induced cholestasis was published in Hepatology in 2011. Secondary sclerosing cholangitis (SSC) due to drugs has been well documented for several different drugs. Check point inhibitors (CPIs) are one of the types of drugs shown to lead to SSC. Several new herbal and dietary supplements have recently been shown to lead to cholestatic liver injury. A number of genetic risk factors for cholestasis due to drugs have been identified in the last decade and the pathogenesis behind cholestatic injury better defined. In this review, the focus is on diagnostic approach, description of new clinical phenotypes such as SSC and vanishing bile duct syndrome. Furthermore, the review provides an overview on the risk factors, genetic determinants and the pathophysiology of hepatobiliary transporters leading to cholestasis. Management, areas of uncertainty and future direction are also presented.

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Role of the Surgical Pathologist in Diagnosis of Drug-induced Liver Injury: Recognizing Specific Patterns of Drug Injury

Chopra

Gawrieh

Vuppalanchi

et al. 2021

Advances in Anatomic Pathology

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Eighteen histologic patterns of drug-induced liver injury (DILI) are described, most of which are also seen in other commonly occurring acute and chronic liver diseases. However, certain patterns such as sinusoidal obstruction syndrome/veno-occlusive disease, "bland" cholestasis and cholestatic hepatitis are more often caused by drugs than other competing etiologies. Amiodarone, acetaminophen, anabolic androgenic steroids and estrogens, result in histologic patterns that are virtually diagnostic of the respective drug. Recognition of a DILI or drug specific injury pattern enables the clinician to focus on eliciting an appropriate history to identify the offending agent, which may otherwise be rare and not immediately apparent. Although drugs can mimic any and every liver disease, the mimicry is often imperfect. Unusual features that do not completely fit the clinicopathologic paradigm of the mimicked liver disease are clues to diagnosis of DILI. When mimicking a liver disease, drugs tend to hasten or accelerate the natural progression of the disease. Novel immunomodulatory drugs for inflammatory disorders and cancer may cause unintended effects on the immune system, resulting in immune-related side effects. The role of the pathologist in diagnosis of DILI is to recognize known patterns of DILI, and either confirm a diagnosis when clinically suspected, or alert the clinician to the possibility of DILI when it is not suspected. The latter is particularly vital in contemporary practice, which is witnessing an accelerated pace of drug development, and a surge in consumption of nutritional supplements and herbal compounds by an increasingly health conscious society.

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An Unusual Cause of Cholestatic Hepatitis: Syphilis

Cited by 6 publications

References 10 publications

Palmoplantar exanthema and liver dysfunction

Palmoplantar exanthema and liver dysfunction

Drug-induced cholestatic liver diseases

Role of the Surgical Pathologist in Diagnosis of Drug-induced Liver Injury: Recognizing Specific Patterns of Drug Injury

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