Secondary syphilis presenting with jaundice

Bhowmick, B K; Simpson, Brittany; Way, S. P. B.

doi:10.1136/pgmj.51.596.412

Cited by 14 publications

(13 citation statements)

References 7 publications

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“…The elevation of the alkaline phosphatase is likely due to pericholangiolar inflammation 10,18. Cases also may present with elevated AST and ALT levels;6,19 while no case in our series had an elevated total bilirubin level, jaundice has been previously reported 20,21. Laboratory studies may also reveal renal involvement, most often seen as isolated proteinuria 22–24…”

Section: Discussionmentioning

confidence: 47%

“…10,18 Cases may also present with elevated AST and ALT levels; 6,19 while no case in our series had an elevated total bilirubin level, jaundice has been previously reported. 20,21 Laboratory studies may also reveal renal involvement, most often seen as isolated proteinuria. 22 -24 The most common clinical finding among HIV-infected patients with syphilitic hepatitis was the rash of secondary syphilis.…”

Section: Discussionmentioning

confidence: 99%

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Syphilitic hepatitis among HIV-infected patients

2009

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Summary Syphilis is an important public health issue which continues to occur at high rates among HIV-infected patients. Although abnormal liver function tests are common among HIV-infected persons, the incidence of syphilitic hepatitis in this population is currently unknown. We present two cases of syphilitic hepatitis and performed a retrospective study to determine the incidence of hepatitis during early syphilis infections among HIV-infected persons. Our study showed that syphilitic hepatitis is common occurring in 38% (12/32) of HIV-positive patients with early stages of syphilis infection. Most cases occurred during secondary syphilis with the most common finding being a maculopapular rash. Syphilis should be included in the differential diagnosis of HIV patients presenting with liver test abnormalities, rash and/or sexual risk factors.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Syphilitic hepatitis among HIV-infected patients

2009

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“…Liver involvement in syphilis has been recognized for 400 years, 6 but is uncommon and tends to be overlooked. After the first systematic autopsy description of liver damage in the course of syphilis, made by Hahn 7 in 1943, sporadic case reports or small series were published in the literature, 825 but in recent years the incidence of primary and secondary syphilis has increased, especially among people engaged in unsafe sexual practices. 26…”

Section: Discussionmentioning

confidence: 99%

Early syphilitic hepatitis in an immunocompetent patient: really so uncommon?

Noto¹,

Nonno

Licci

et al. 2008

Int J STD AIDS

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The incidence of syphilis has increased substantially over the past years, particularly in men who have sex with men. The clinical manifestations of syphilis are variable and liver involvement is uncommon, but may occur at any stage of the disease. We report a case of early syphilitic hepatitis (ESH) in an immunocompetent patient referring multiple bisexual exposures, who presented at admission with jaundice, tiredness, an ulcerated genital lesion and an increase of liver aminotransferases. During his hospital stay, he developed a skin rash, and serology for syphilis was found positive. Our case report strengthens the need to take into consideration the diagnosis of ESH in all patients with unexplained liver enzyme increase and epidemiological data of unsafe sexual exposures. Indeed, an early recognition of the clinical manifestations of syphilis can lead to a prompt treatment, and allows the prevention of the transmission of this disease to other individuals.

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“…Some prior reports have also noted acute hepatitis in patients ultimately diagnosed with syphilis hepatitis. 15,23,40,45,49,58 One case in our cohort demonstrated histologic findings mimicking autoimmune hepatitis, namely portal, interface, and lobular inflammation dominated by plasma cells. Autoimmune hepatitis was also on the clinical differential diagnosis, and serum IgG was elevated, though additional serology was not available and the patient had an AP of 727 IU/L (markedly elevated) but AST of 120 IU/L and ALT of 176 IU/L (modestly elevated), whereas patients with autoimmune hepatitis usually have AST and ALT elevated more strikingly than AP.…”

Section: Discussionmentioning

confidence: 75%

Hepatic Secondary Syphilis Can Cause a Variety of Histologic Patterns and May Be Negative for Treponeme Immunohistochemistry

Malvar

Cardona

Pezhouh

et al. 2021

American Journal of Surgical Pathology

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The rate of syphilis in the United States has been increasing steadily in the past decade, but it remains an uncommon diagnosis in tissue biopsies. Most of the pathology literature on hepatic syphilis consists of older series or case reports. This study aimed to systematically characterize the histologic spectrum of hepatic syphilis in a contemporary cohort. Clinicopathologic features of 14 hepatic syphilis cases between 2012 and 2018 were analyzed to characterize the broad spectrum of histologic changes. Thirteen patients were men (age range: 19 to 59 y); 6 had known human immunodeficiency virus, 7 were men known to have sex with men, and no patient had known prior syphilis. Hepatic syphilis was the primary clinical suspicion in only 1 patient. Common symptoms included jaundice, rash, and abdominal pain. Thirteen had elevated transaminases, and 12 had elevated alkaline phosphatase. Pathologic changes were grouped into 5 histologic patterns: biliary-pattern injury (n = 5), acute hepatitis (n = 4), autoimmune hepatitis-like (n = 1), fibroinflammatory mass-forming lesion (n = 2), and no particular pattern (n = 2). Nearly all showed portal and lobular lymphocytes and plasma cells; 12 had prominent histiocytes/Kupffer cells, 9 had ductular reaction, and 7 had duct inflammation. Occasional focal findings included dropout (n = 7), phlebitis (n = 7), and loose granulomata (n = 5). Treponeme immunohistochemistry was positive in 10 and negative in 4, though treatment was given before biopsy in 3 of those 4. Thirteen patients had rapid plasma reagin testing either before or after biopsy, with 1:64 or higher titer. All patients who received treatment recovered. Hepatic syphilis is rare but likely underrecognized. It exhibits a variety of histologic appearances and therefore should be considered in several hepatic differential diagnoses, especially in men who have sex with men. Kupffer cells, granulomata, and phlebitis may suggest the diagnosis regardless of predominant histologic pattern. Negative treponeme immunohistochemical staining does not exclude the diagnosis, including in untreated patients.

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Secondary syphilis presenting with jaundice

Cited by 14 publications

References 7 publications

Syphilitic hepatitis among HIV-infected patients

Syphilitic hepatitis among HIV-infected patients

Early syphilitic hepatitis in an immunocompetent patient: really so uncommon?

Hepatic Secondary Syphilis Can Cause a Variety of Histologic Patterns and May Be Negative for Treponeme Immunohistochemistry

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