Authors response to correspondence regarding paper entitled Syphilitic hepatitis: a case report and review of the litera
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Authors response to correspondence regarding paper entitled Syphilitic hepatitis: a case report and review of the literature Jiaofeng Huang1, Bo Wan2,3, Mingfang Wang1, Yueyong Zhu1 and Su Lin1*
Abstract In the correspondence from Abdurrahman et al., they raised three main concerns and critiques of our recently published article entitled “Syphilitic hepatitis: a case report and review of the literature”. First question pertains to the timing of dermatology opinion, second regarding the history of sexual exposure, and lastly regarding the treatment duration of syphilitic hepatitis. We thank the authors for their constructive comments and would like to answer these questions in detail. Keywords: Syphilis, Hepatitis, Rashes We appreciate the detailed review and commentary on our manuscript [1] from Abdurrahman et al. [2]. The first concern is regarding the timing of dermatology consult and syphilitic rashes. The patient described in our manuscript had two dermatology consultation. The first consult was at the local hospital when the rashes were noticed, and the second consult at our referral hospital upon admission. At both consultation with dermatologist, the opinion was that the rashes were secondary to an allergic reaction. The complete clinical examination of the genitals, palms and soles but did not reveal any skin lesions. Syphilitic rashes are known to occur in around 80% of patients with syphilitic hepatitis [3], and often present as multiple non-pruritic, erythematous, nonconfluent maculopapular lesions generally concentrated in the trunk, palms and soles of the feet. We agree with the authors that if the correct diagnosis of syphilitic hepatitis This reply refers to the comment available online at https://doi.org/10.1186/ s12876-020-01496-5 *Correspondence: [email protected] 1 Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou 350001, Fujian, China Full list of author information is available at the end of the article
could have been made earlier, the invasive liver biopsy could have been avoided. This is precisely the reason why we decided to report this particular case. Second, Abdurrahman et al. noted that we did not describe the patient’s sexual history in detail, we agree with him on this point. In fact, the patient denied a history of unsafe sexual activity upon admission, which we duly stated in the manuscript. Interestingly, even after the syphilis infection was confirmed, patient still denied any history of unsafe sexual activity. However, even in the absence of a clear high risk sexual history, the antibody positivity was still powerful evidence of the diagnosis of Syphilis infection. The third question Abdurrahman et al. raised is about the duration of antibiotics administered to patient for syphilitic hepatitis. The recommended duration of antibiotic administration is 2–4 weeks [4]. The reported patient was discharged after the first dose of pen
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