Syphilitic hepatitis: a case report and review of the literature
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CASE REPORT
Open Access
Syphilitic hepatitis: a case report and review of the literature Jiaofeng Huang1, Su Lin1, Mingfang Wang1, Bo Wan2 and Yueyong Zhu1*
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: Syphilis, Hepatitis, Rashes, Enzymes, Infection
Background Syphilis is a multi-systemic disease caused by spirochete Treponema pallidum. Liver is one of the organs that can be affected [1]. Congenital syphilitic hepatitis is more common and easily recognized for its typical clinical features, while acquired syphilitic hepatitis in adults were rarely reported. Here we present a clinical case of syphilitic hepatitis whose diagnosis has been confirmed by the pathology of liver biopsy. Case presentation A 47-year-old man was hospitalized because of jaundice and rashes. He developed jaundice 2 weeks prior to admission. He had no fever, fatigue, anorexia, abdominal pain, or waist pain. The laboratory examinations in local hospital revealed an alanine aminotransferase (ALT) of 359 U/L, an aspartate aminotransferase (AST) of 161 U/L, * Correspondence: [email protected] 1 Department of Liver Research Center, the First Affiliated Hospital of 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
an alkaline phosphatase (ALP) of 580 U/L, a gammaglutamyl transpeptidase (GGT) of 883 U/L and a total bilirubin (TBIL) of 75.1 umol/L. He received a liver protective medication (diammonium glycyrrhizinate), but jaundice did not improve. On the third day of diammonium glycyrrhizinate treatment, multiple non-itchy rashes appeared all over his body, which remained after the withdrawal of diammonium glycyrrhizinate and the application of antiallergic agents. In addition, his ALP and GGT increased
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