University of Alabama at Birmingham Homewood, AL, United States
Nishah Panchani, MD, Mohamed Shoreibah, MD University of Alabama at Birmingham, Birmingham, AL
Introduction: Syphilis is a sexually transmitted infection that infects individuals at increasing rates every year. Syphilitic hepatitis (SH) is known to be a very rare complication of the infection, and can often be missed as a diagnosis.¹ Here we present a unique case of SH disguised as what appears to be seronegative autoimmune hepatitis (AIH).
Case Description/Methods: A 25 year old African-American female with history of tobacco and cannabis use presented with a 1 month history of fatigue, lymphadenopathy, that went away prior to presentation, and recent onset of pruritus, nausea and vomiting. She denied any risk factors for viral hepatitis or new medications. Physical exam was unremarkable except for sublingual and conjunctival icterus. Labs were significant for AST 1042 [12-39 U/L], ALT 877 [7-52 U/L], and ALP 189 [37-117 U/L]. Total bilirubin was 19.7 (direct 17.3). GGT and IgG were normal. Acute hepatitis panel, ANA, ASMA, AMA, and anti-LKM titers were negative. Wilson’s disease and alpha-1-antitrypsin deficiency were ruled out. Rapid plasma reagin (1:128) and Treponema antibody levels were positive. She had hepatomegaly with no ductal dilatation on ultrasound and MRCP. Liver biopsy was significant for peri-central and patchy sinusoidal congestion, canalicular cholestasis, and inflammatory portal tract infiltrates with bridging inflammation. Iron, PAS, VZV and spirochetes stains were negative. The patient was treated with penicillin for syphilis and started on prednisone for a suspicion of seronegative AIH. Steroid treatment was discontinued after a month due to concern for SH. Repeat liver enzymes were within normal limits 2 weeks after the prednisone was stopped and continued to remain normal.
Discussion: SH is known to cause higher elevations in GGT and ALP, unlike our case, along with moderately impressive total bilirubin rise. There has been one report to date that identifies a case of concurrent SH and AIH, with a more impressive rise of AST and ALT.² Our case is the first to present as SH with a questionable diagnosis of seronegative AIH.
1. Huang, Jiaofeng et al. “A Systematic Literature Review of Syphilitic Hepatitis in Adults.” Journal of clinical and translational hepatology vol. 6,3 (2018): 306-309. doi: 10.14218/JCTH.2018.00003
2. Baliss, Michelle, et al. “The Great Spiral Masquerader: A Case of Concurrent Secondary Syphilis and Autoimmune Hepatitis.” ACG Case Reports Journal, vol. 7, no. 9, 2020, p. e00451–, doi:10.14309/crj.0000000000000451.
Disclosures: Nishah Panchani indicated no relevant financial relationships. Mohamed Shoreibah indicated no relevant financial relationships.
Nishah Panchani, MD, Mohamed Shoreibah, MD. P0821 - A Case of Syphilis Masked as Seronegative Autoimmune Hepatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.