The liver in secondary syphilis clinical, laboratory and histopathological investigation of 22 patients without jaundice

Abstract

IN T R O D U C T IO NMany authors have studied the causai relationship between jaundice, liver lesions and secondary syphilis by means of case reports1' 2' 12' 17,2 ' 22' 30. Few have studied the liver in early syphilitic patients without jaundice. In these studies some of the cases cited had been admitted to the ward for re ason s other than suspected syphi-||S1 5,2 3 ,26,31Before the current use of liver biopsy, Irgang9 and Hahn8 suggested an underlying hepatitis in secondary syphilis.Féher et al6 made a systematic investigation of syphilitic patients who had altered liver function tests by means of liver biopsy.Rajam and Rangiah19, Mc Cracken et al15 and now Sherlock24 suggested a liver investigation by needle biopsy in early syphilitic patients without clinicai nor laboratory evidence of hepatic lesion.The authors studied 22 volunteers with secondary syphilis using liver function tests and needle biopsy. M A T E R IA L A N D M E T H O D S22 patiens were selected for this study. They ali related a history of syphilitic contact and showed secondary syphilitic skin lesions* None of them related excessive use of alcohol and none had any hepatic symptomatology. Of them 12 were women. Their ages ranged between 18 and 43 years. The time between onset of symptoms of secondary syphilis and needle biopsy varied from 4 to 90 days.Each patient had at least two different serologically positive tests for syphilis (V D R L , Kahn and Maltaner).The liver function tests performed were: bilirubin, alkaline serum phosphatase, glu tam ic pyruvate transaminase (SGPT), cholesterol serum proteins (total, fractioned and electrophoresis), flocculation reactions and prothrombin activity.Ali patients had a needle biopsy done, after which they were treated with penicillin.A li biopsy specimens were wholly or partially fixed in formaldehyde 4% and paraffin embedded. The sections were stained by routine HE, PAS, delayed ZiehlNeelsen for ceroid pigment (Scheuer, 1968) and afterwards by the Warthin-Faulkner technique for treponema detection5. A specimen from congenital renal syphilis was included in each battery of slides as a positive reference rich in treponemes.