Secondary syphilitic hepatitis in a fourteen-year-old male youth

Abstract

An unusual case of a secondary syphilitic hepatitis in a 14-year-old male youth is presented. Although he had extremely high aspartate and alanine aminotransferase values, improvement was rapid after antibiotic therapy. Histologic examination of the liver performed during convalescence revealed patchy necrosis and inflammatory cell infiltration.

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

“…In addition, histological features, including nonspecific portal inflammatory infiltrates, periportal hepatocyte necrosis, and pericholangiolar inflammation, were also consistent with syphilitic hepatitis reported previously (6,8). As in the present case, identification of spirochetes in liver biopsy specimens failed in the majority of published cases (5)(6)(7)9). There are various pathogeneses, such as direct portal venous inoculation and immune complex-mediated disease (6); however, given the rarity of detecting spirochetes in liver specimens, direct hepatotoxicity of the microorganism seems to be unlikely.…”

Syphilitic hepatitis resulting in fulminant hepatic failure requiring liver transplantation

“…A case of severe syphilis-associated hepatic dysfunction was described in a 14-year old boy; but he never developed encephalopathy or coagulopathy and recovered fully. 5 Additionally, while syphilitic hepatitis has been detected in 20% of children with congenital syphilis 3 there has only been two reports of fulminant hepatic failure in this population. 6,7 There have been no reports of fulminant hepatic failure in an adult in the setting of active syphilis.…”

“…3 While this cholestatic pattern is more common, some cases have shown predominately hepatocelluar damage. 5 Liver biopsy is often non-specific, typically demonstrating periportal lymphocytic infiltration with focal necrosis of hepatic cells around central veins, portal areas, and lobules. 8e12 Trepenomes or granulomatous changes are visualized in only about half of cases.…”

“…3,5 It has been postulated that Treponema pallidum directly invades the liver via the portal circulation following anal infection. Because our patient has engaged in numerous sexual encounters the past year, the route of transmission is unknown.…”

Cholestatic Hepatitis and Thrombocytosis in a Secondary Syphilis Patient

“…Laboratory findings include a modest increase in transaminases and bilirubin, but a marked increase in ALP and GGT (11). While this cholestatic pattern is more usual, some cases have shown predominantly hepatocellular damage (12). We could find the predominantly cholestatic pattern in our patient.…”