Hepatitis in patients with syphilis: an overlooked association

Abstract

We present the case of a patient who sought treatment for fever and a maculopapular rash involving the trunk, limbs, palms and soles. The patient also presented with hepatomegaly and elevated levels of liver enzymes (with a higher increase of alkaline phosphatase). With the proposal of early syphilitic hepatitis, during the stage of secondary syphilis, a venereal disease research laboratory and Treponema pallidum haemagglutination tests were requested, which confirmed the diagnosis. All altered parameters improved with antibiotic treatment for secondary syphilis. Syphilitic hepatitis is an often overlooked presentation of syphilis and should be considered as a differential diagnosis in patients with elevated levels of liver enzymes and risk factors for syphilis.

Syphilitic hepatitis: Case report of an overlooked condition

“…Syphilitic hepatitis is a rare clinical presentation of syphilis, with an incidence ranging from 0.25% to 38% . It occurs relatively more frequently among men who engaged in sexual intercourse with men or with patients with HIV infection, but the disease can emerge in any individual who gets infected .…”

“…Syphilitic hepatitis is a rare clinical presentation of syphilis, with an incidence ranging from 0.25% to 38%. 5,6 It occurs relatively more frequently among men who engaged in sexual intercourse with men or with patients with HIV infection, but the disease can emerge in any individual who gets infected. 7 Even though a local inflammatory response elicited by spirochetes is believed to be the cause of all clinical manifestations of syphilis, the precise mechanisms by which T pallidum causes liver damage and the reason behind certain patients with infection developing hepatitis while others do not remain unclear.…”

“…7 Even though a local inflammatory response elicited by spirochetes is believed to be the cause of all clinical manifestations of syphilis, the precise mechanisms by which T pallidum causes liver damage and the reason behind certain patients with infection developing hepatitis while others do not remain unclear. 1,6 Hepatic involvement in syphilis can be observed during any phase of the disease. A systematic review that includes 144 patients found that 89% of cases develop during early syphilis and 6% during late stages.…”

“…2 Antibiotic treatment shows rapid improvement in the majority of cases of syphilitic hepatitis. [6][7][8]13 Very rarely, syphilitic hepatitis can result in fulminant liver failure, as shown in the case of a patient who required a liver transplantation. 14 In summary, this case report highlights syphilis as an overlooked etiology of hepatitis that should always be excluded during the evaluation of patients with abnormal liver biochemical marker levels of unknown etiology.…”

“…Antibiotic treatment shows rapid improvement in the majority of cases of syphilitic hepatitis . Very rarely, syphilitic hepatitis can result in fulminant liver failure, as shown in the case of a patient who required a liver transplantation …”