Syphilitic hepatitis: a case report and review of the literature

Abstract

Background: Syphilis is a common disease that has been researched and focused on for many years, however, syphilitic hepatitis has not been well-recognized. We report this case of syphilitic hepatitis with intrahepatic cholestasis and liver granulomas to make a deeper impression.

Case presentation: A 47-year-old male was admitted with jaundice and rashes. The laboratory examination showed abnormal liver enzymes with significant increases in ALP and GGT but mild increases in ALT and AST. His HBV surface antigen was weakly positive, with negative HIV antibody, HCV antibody, and undetectable HBV DNA. The rapid plasma reagin test and the Treponema pallidum particle assay tests for Syphilis were both positive. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed the normal biliary tract, liver, and spleen. The liver pathological examination showed cholangiocyte inflammation and micro-granulomas with coagulation necrosis. After 2 months of benzathine penicillin treatment, his liver enzyme decreased rapidly and remained normal after 1-year of follow-up.

Conclusions: Increased liver enzymes, intrahepatic cholestasis and liver granulomas with well-response to antibiotics may provide clues for the diagnosis of syphilitic hepatitis.

Keywords: Enzymes; Hepatitis; Infection; Rashes; Syphilis.

Fig. 1

Patient’s body appearance and histological findings. a multiple erythematous macules and hyperpigmentation on the back; b, multiple erythematous macules and hyperpigmentation over the belly; c, HE staining shows bile duct epithelial cell injury, atrophy cholangiocyte, and portal tract inflammation (× 400); d, CK7 staining of cholangiocyte reveals atrophy cholangiocyte and bile duct lesion (× 100); e, HE staining shows granulomas (× 400); f, CD68 staining of macrophagocyte shows granulomas (× 100). Black arrows indicate lesions