1
|
Supronowicz Ł, Rogalska M. Syphilitic hepatitis. Clin Exp Hepatol 2024; 10:9-13. [PMID: 38765910 PMCID: PMC11100338 DOI: 10.5114/ceh.2024.136235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/16/2023] [Indexed: 05/22/2024] Open
Abstract
Syphilis is a sexually transmitted multisystemic disease known as "the great imitator" due to its variable presentations. Despite being preventable and curable, it still constitutes a major health problem. Hepatic manifestation of syphilis is usually mild cholestatic liver injury but in very rare cases can become fulminant. Moreover, syphilitic hepatitis, known for several decades, is considered rare but is probably under-diagnosed. Given the significant morbidity associated with a missed diagnosis, syphilitic hepatitis should be taken into account as an element of differential diagnosis in patients with unexplained elevation of liver enzymes.
Collapse
Affiliation(s)
- Łukasz Supronowicz
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Poland
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Poland
| |
Collapse
|
2
|
Yang CC, Chen JY, Chang HY, Sheu MJ, Feng IC, Wang SH, Kuo HT. Cholestatic Hepatitis with Concomitant Nephrotic Syndrome due to Secondary Syphilis in a Young Man. Case Rep Gastroenterol 2024; 18:136-143. [PMID: 38501149 PMCID: PMC10948170 DOI: 10.1159/000537922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Syphilis, an ancient sexually transmitted disease, is recognized as a systemic infection disease manifesting with diverse symptoms and variations. Secondary syphilis characterized by systemic symptoms resulted from hematogenous and lymphatic dissemination of the infection, may include manifestations such as hepatitis and nephrotic syndrome. However, the simultaneous occurrence of hepatitis and nephrotic syndrome in secondary syphilis is rare. Case Presentation A young man presented with fatigue, abnormal liver function tests, and hyperbilirubinemia and had history of men who have sex with men (MSM). Serological tests confirmed the diagnosis of secondary syphilis, and kidney biopsy indicated membranous nephritis. After antibiotic treatment, the patient experienced resolution of proteinuria, and liver enzyme levels returned to normal. Conclusion Syphilis should be considered in the differential diagnosis of simultaneous liver and kidney dysfunction, particularly in patients engaging in high-risk sexual behavior. This case highlights the importance of considering syphilis in young patients with MSM and presenting with unexplained nephrotic syndrome and liver abnormalities.
Collapse
Affiliation(s)
- Chun-Chi Yang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsuan-Yuan Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jen Sheu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - I-Che Feng
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Su-Hung Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
3
|
Orozco-Sebá BE, Viasus D, Meléndez E, Fuentes J, Tovar J, Amado EA, Loaiza D. Intrahepatic cholestasis due to Treponema pallidum in an immunocompetent patient. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:164-170. [PMID: 37433168 PMCID: PMC10513144 DOI: 10.7705/biomedica.6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/11/2023] [Indexed: 07/13/2023]
Abstract
Hepatitis due to Treponema pallidum is a rare entity and its diagnosis represents a clinical challenge. Treponema pallidum should be considered as a presumptive etiology in all patients with acute liver disease, when other frequent causes have been ruled out. We present the case of a young, immunocompetent patient with elevated values in his liver tests, a cholestatic pattern, and maculopapular lesions on his palms and soles. Given his clinical picture, diagnostic tests, and response to the antimicrobial therapy, a diagnosis of cholestasis due to secondary syphilis has been established. It is important to include secondary syphilis within the possible causes of acute liver disease.
Collapse
Affiliation(s)
- Beatriz E Orozco-Sebá
- Programa de Dermatología, División de Ciencias de la Salud, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia.
| | - Diego Viasus
- División de Ciencias de la Salud, Facultad de Medicina, Hospital Universidad del Norte de Barranquilla, Universidad del Norte, Barranquilla, Colombi.
| | - Esperanza Meléndez
- Programa de Dermatología, División de Ciencias de la Salud, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia.
| | - Jairo Fuentes
- Programa de Dermatología, División de Ciencias de la Salud, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia.
| | - José Tovar
- Programa de Dermatología, División de Ciencias de la Salud, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia.
| | - Elkin A Amado
- División de Ciencias de la Salud, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia.
| | - Daniela Loaiza
- División de Ciencias de la Salud, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia.
| |
Collapse
|
4
|
Plesa A, Gheorghe L, Hincu CE, Clim A, Nemteanu R. Making a Comeback: Syphilitic Hepatitis in a Patient with Late Latent Syphilis-Case Report and Review of the Literature. Pathogens 2022; 11:pathogens11101151. [PMID: 36297208 PMCID: PMC9608871 DOI: 10.3390/pathogens11101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Treponema pallidum infection has emerged in recent years as an important community threat and burden to the health care system. Here, we report the case of a patient with cholestatic liver disease secondary to late latent syphilis. A 41 year-old male patient was referred to the clinic for assessment of an abnormal liver function panel. Ultrasound of the abdomen demonstrated an intense liver echogenicity, normal bile ducts, and no ascites. Virologic study revealed negative results for antibodies against common viral hepatitis and metabolic and autoimmune disease. The patient was tested for syphilis and a positive result was reported. The patient was diagnosed with late latent syphilis and syphilitic hepatitis and initiated benzathine penicillin at G 7.2 million units total, delivered as three doses of 2.4 million units intramuscular each at one-week intervals. He was assessed monthly and by the end of the sixth month, he had nonreactive VDRL (seroconversion), which confirmed recovery. Syphilitic hepatitis is an overlooked type of hepatitis and should be kept in mind as a differential diagnosis in an abnormal liver panel of uncertain etiology. Health care providers should be advised that higher levels of ALP may be the single landmark in cases of syphilitic hepatitis.
Collapse
Affiliation(s)
- Alina Plesa
- Medical I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sfantul. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Liliana Gheorghe
- Medical I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Radiology, “Sfantul Spiridon” Hospital, 700111 Iasi, Romania
- Correspondence: (L.G.); (R.N.)
| | - Corina Elena Hincu
- Department of Radiology, “Sfantul Spiridon” Hospital, 700111 Iasi, Romania
| | - Andreea Clim
- Medical I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Roxana Nemteanu
- Medical I Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sfantul. Spiridon” University Hospital, 700111 Iasi, Romania
- Correspondence: (L.G.); (R.N.)
| |
Collapse
|
5
|
Mujumdar S, Goldenberg J, Bieser S, Pang AS, Coben R. Cholestatic Liver Injury in a Patient with Tertiary Syphilis. Case Rep Gastroenterol 2022; 16:552-556. [PMID: 36824700 PMCID: PMC9941764 DOI: 10.1159/000526247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Syphilis is a common infection that has variable presentations. We report a rare case of a 64-year-old male with 3 weeks of abdominal pain, back pain, and neurologic deficits including memory impairment who was found to have neurosyphilis causing a cholestatic liver injury. Workup included a positive rapid plasma reagin (RPR) and enzyme immunoassay (EIA), a positive cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL), and a liver biopsy, which was compatible with a diagnosis of syphilitic hepatitis. Completion of a 14-day course of penicillin and 1 month of physical therapy resulted in near full-functional and biochemical recovery.
Collapse
Affiliation(s)
- Sahaj Mujumdar
- aDepartment of Internal Medicine Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA,*Sahaj Mujumdar,
| | - Jason Goldenberg
- aDepartment of Internal Medicine Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Steven Bieser
- bSidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alice S. Pang
- cDivision of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert Coben
- cDivision of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Abstract
In the United States, the incidence of new cases of syphilis has been rising. The number of cases of primary and secondary syphilis has continued to increase almost every year over the past 2 decades. Secondary syphilis has a variety of clinical manifestations. A frequently overlooked presentation is that of syphilitic hepatitis, which should be part of the differential diagnosis for patients with elevated liver enzymes, a maculopapular rash, and/or risk factors for contracting syphilis. In this study, we report a rare and unusual case of a man with a remote history of syphilis infection who developed acute liver injury.
Collapse
|
7
|
Kasper P, Martin A, Nierhoff D, Goeser T. Cholestatic hepatitis with concomitant nephrotic syndrome due to late syphilis in an immunocompetent 32-year-old man. BMJ Case Rep 2020; 13:e232615. [PMID: 32029514 PMCID: PMC7021109 DOI: 10.1136/bcr-2019-232615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 12/13/2022] Open
Abstract
A 32-year-old man was referred to our clinic for evaluation of abnormal liver function tests and concurrent proteinuria. Physical examination revealed a maculopapular rash, involving the trunk and palms, and multiple 'moth-eaten' patches of alopecia. After a prolonged diagnostic work-up a hepatitis with concomitant nephrotic syndrome due to secondary syphilis was diagnosed. Treatment with benzylpenicillin led to complete clinical recovery. Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.
Collapse
Affiliation(s)
- Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany
| | - Anna Martin
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany
| | - Dirk Nierhoff
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany
| |
Collapse
|