TITLE:
Acute Syphilitic Hepatitis in the Early Secondary Phase: A Case Report and Literature Review
AUTHORS:
Paul Ngock, Jacques Mauillon, Larry Tangie, Antonin Ndjitoyap, Célestin Danwang, Firmin Ankouane
KEYWORDS:
Acute Hepatitis, Rash, Syphilis
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.12 No.3,
March
11,
2022
ABSTRACT: Background: The incidence of syphilis is clearly increasing. It is a source of
visceral damage, particularly in the secondary phase. Acute syphilitic
hepatitis is a rare clinical entity classically described but under-diagnosed
because of its non-specific presentation. Case Presentation: We
report the case of a 25-year-old French woman, without comorbidity, sexually
active, having unprotected sex with only one partner. She was admitted to our
unit for jaundice and a disturbed liver function test preceded 3 weeks earlier
by a rash. The patient did not consume alcohol and did not report the
introduction of a new medication. A skin rash compatible with syphilitic
roseola and generalized adenopathy were found. The liver workup showed alanine
aminotransferase (ALT) at 1984 U/L, aspartate aminotransferase (AST) at 1377
U/L, total bilirubin at 221 μmol/L, alkaline phosphatase activity (APL) at 419
U/L, gamma glutamyl transferase activity (GGT) at 229 U/L and a prothrombin
concentration at 73%. The search for the most common etiologies of acute
hepatitis was negative. Syphilitic serology was positive with a Treponema
Pallidum Hemagglutinations Assay (TPHA) titration of 5120 IU and Veneral
Disease Research Laboratory (VDRL) of 64 IU. Abdominal ultrasound revealed only
homogeneous hepatomegaly and splenomegaly with no focal lesions. Other sexually transmitted infections (STI)
were negative and her partner had positive syphilis serology. After a
single dose of Benzathine benzylpenicillin, the clinical signs regressed after
one week and the hepatic balance tended to normalize 20 days later. Conclusion: This highlights the need for a high index of suspicion for syphilitic hepatitis in sexually active patients presenting
with acute hepatitis associated with a cutaneous rash.