Secondary syphilis with liver involvement in a liver transplant recipient

Abstract

Syphilis is capable of compromising almost any organ; however, syphilitic hepatitis is a rare manifestation that has been described most often in HIV‐infected patients. Herein, we present a 33‐year‐old male liver transplant recipient who presented with progressive liver dysfunction characterized by mild ALT elevation and rising cholestasis, malaise, skin rash, and alopecia. Skin biopsy was characteristic of secondary syphilis, confirmed by both skin and liver biopsy‐positive immunohistochemical staining for Treponema pallidum. The patient was treated with benzathine penicillin G 2.4 million units IM q week × 3 weeks. Three months later, the patient was asymptomatic and recovered from his general malaise. He showed no skin lesions and demonstrated complete regrowth of the hair on his scalp, beard, and eyebrows. The presence of liver dysfunction with cholestasis in a transplant recipient should alert transplant providers to the possibility of syphilitic hepatitis, particularly in men who have sex with men. Though not an early manifestation, cutaneous signs of secondary syphilis may be a helpful diagnostic indicator in most cases.

Eyebrow and Eyelash Alopecia: A Clinical Review

“…Patients with leprosy should be treated with this standard-of-care regimen regardless of eyebrow involvement. In syphilis , timely treatment with benzathine penicillin G has been reported to result in complete eyebrow regrowth in two case reports [ 51 , 101 ]. Eyebrow and eyelash alopecia due to tinea faciei has been reported to be reversible after treatment with topical and/or oral antifungals in two case reports [ 54 , 102 ].…”

Delayed diagnosis and treatment of secondary syphilis in pancreas–kidney transplant recipient: Need for increased awareness of sexually transmitted infections in solid organ transplantation

“…Given the immediate treatment post-transplantation, donor-derived syphilis cases are often asymptomatic, but recipients will demonstrate seroconversion. 8,9 One report describes a lung transplant recipient with isolated immunoglobulin-G (IgG) seroconversion after receipt of lungs from a donor with serologic evidence of past syphilis infection. 7 As a common and easily treatable infection, syphilis should not be forgotten outside of the peri-transplant period.…”

“…Among liver transplant recipients, secondary syphilis can manifest as luetic hepatitis and should be considered in sexually active patients with unexplained elevated liver function tests (particularly if alkaline phosphatase is predominant abnormality); luckily, treatment with penicillin results in normalization of graft function. 8,9 Neurosyphilis has also been reported in SOT recipients, highlighting a potential susceptibility to neurologic disease. A renal transplant recipient with ocular syphilis experienced delayed diagnosis after 11 months of progressive visual symptoms.…”