University of Texas Health Science Center at Houston houston, TX, United States
Darshan K. Patel, MD, Sara Ali, MD, Preethi Reddy, MD University of Texas Health Science Center at Houston, Houston, TX
Introduction: Syphilis is a well-known disease with a surprisingly notable disease burden in the United States. If left untreated, syphilis can also affect the GI tract and liver due to the hematogenous and lymphatic spread of the spirochetes. We present a 20-year-old female presenting with jaundice, polyarticular arthralgia, and a palmar rash with a mixed pattern liver injury.
Case Description/Methods: 20-year-old African American female with sickle cell trait, asthma, and chlamydia cervicitis presented to the emergency room with jaundice and joint pains. She was referred by her primary care physician for up-trending liver enzymes. She reported no allergies to medications and was taking ibuprofen as needed for pain. She had no recent travel or sick contacts. She was a social alcohol user. Physical exam was notable for scleral icterus, macular rash involving both palms, and a small round erythematous papule on right dorsal forearm. Labs were notable for ALT 218 U/L, AST 333 U/L, ALP 1053 IU/L, total bilirubin 3.6 mg/dL. Acute hepatitis panel as well as autoimmune work up was unremarkable. Given her rash and joint pains, treponemal antibody was ordered and resulted positive with RPR titer of 1:128. She was treated with one dose of IM benzathine penicillin for treatment of secondary syphilis with subsequent improvement in liver enzymes.
Discussion: Syphilitic hepatitis is a rare manifestation of secondary syphilis. Syphilitic hepatitis was first described by Harn in 1943. The diagnostic criteria of syphilitic hepatitis: abnormal liver enzyme levels, serologic evidence of syphilis, exclusion of other causes of liver injury, and normalization of liver enzyme after treatment of syphilis. Imaging studies are useful to rule out other etiology of liver disease but are non-specific for syphilitic hepatitis. A liver biopsy is not required for diagnosis although it may be helpful. Treatment with IM penicillin G is the gold standard and is effective immediately with normalization of liver enzymes between 3 - 6 weeks. Repeat titer level should be obtained in 6-12 month to monitor for adequate response.
Disclosures: Darshan Patel indicated no relevant financial relationships. Sara Ali indicated no relevant financial relationships. Preethi Reddy indicated no relevant financial relationships.
Darshan K. Patel, MD, Sara Ali, MD, Preethi Reddy, MD. P2928 - A Case of Syphilitic Hepatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.