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Case Reports
. 2021 Jun 16;29(4):280-283.
doi: 10.1159/000516944. eCollection 2022 Jul.

Exploring the Ways of "The Great Imitator": A Case Report of Syphilitic Hepatitis

João A Cunha Neves  1 , Joana Roseira  1 , Helena Tavares de Sousa  1   2 , Rui Machado  3
Affiliations
Case Reports

Exploring the Ways of "The Great Imitator": A Case Report of Syphilitic Hepatitis

João A Cunha Neves et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Introduction: Syphilis is a chronic infection caused by Treponema pallidum. Manifestations of this disease are vast, and syphilitic hepatitis is a rarely depicted form of secondary syphilis.

Case presentation: We report the case of a 63-year-old man with worsening jaundice, maculopapular rash and perianal discomfort. Proctological examination with anoscopy revealed a perianal gray/white area with millimetric pale granules along the anal canal. Liver function tests showed a mixed pattern. Venereal Disease Research Laboratory, T. pallidum hemagglutination assay and IgM fluorescent treponemal antibody absorbance were positive. The patient was successfully treated with a single dose of penicillin G.

Discussion/conclusion: Syphilitic hepatitis is scarcely reported in the literature. Secondary syphilis with mild hepatitis rarely leads to hepatic cytolysis and jaundice. Many signs of secondary syphilis including syphilitic hepatitis may be linked to immune responses initiated during early infection. Over the past decades, evidence has emerged on the importance of innate and adaptive cellular immune responses in the immunopathogenesis of syphilis. This report raises awareness to a clinical entity that should be considered in patients at risk for sexually transmitted diseases, who present with intestinal discomfort or liver dysfunction, as it is a treatable and fully reversible condition.

Introdução: A sífilis é uma infeção crónica provocada pelo Treponema pallidum. As manifestações desta doença são vastas e a hepatite sifilítica é uma forma de sífilis secundária raramente descrita.

Caso clínico: Apresentamos o caso de um doente de 63 anos com icterícia de agravamento progressivo, rash maculopapular e desconforto perianal. O exame proctológico complementado por anuscopia revelou uma região perianal cinzenta-esbranquiçada com grânulos pálidos milimétricos ao longo do canal anal. Testes de função hepática revelaram um padrão misto e o Venereal Disease Research Laboratory, T. pallidum hemagglutination assay e IgM fluorescent treponemal antibody absorbance foram positivos. O doente foi tratado com sucesso com uma dose única de penicilina G.

Discussão/conclusão: São raros os casos de hepatite sifilítica descritos na literatura. Sífilis secundária com hepatite ligeira raramente conduz a citólise hepática e icterícia. Muitos dos sinais de sífilis secundária, incluindo a hepatite sifilítica, parecem estar associados a respostas imunitárias iniciadas durante o período de infeção precoce. Ao longo das últimas décadas, têm surgido evidências crescentes sobre a importância das respostas imunes inata e adaptativa na patogénese da sífilis. Este caso clínico descreve uma entidade nosológica que deve ser considerada em doentes em risco de contraírem doenças sexualmente transmissíveis, que se apresentem com desconforto intestinal ou disfunção hepática, visto tratar-se de uma condição tratável e totalmente reversível.

Keywords: Case report; Secondary syphilis; Syphilis; Syphilitic hepatitis; Treponema pallidum.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Maculopapular rash on the palms.
Fig. 2
Fig. 2
Tubular rectum − hardened and erythematous mucosa with pale nodular lesions.
Fig. 3
Fig. 3
Tubular rectum − hardened and erythematous mucosa with pale nodular lesions.
Fig. 4
Fig. 4
Retroflexion in the rectum − hardened and erythematous mucosa with pale nodular lesions.
See this image and copyright information in PMC

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