A Stubborn Case of Syphilitic Hepatitis

Abstract

Background

Syphilitic hepatitis is a rare occurrence, but delay in its diagnosis can expose patient to unnecessary testing. The treatment available for this condition can also vary from one intramuscular injection of Penicillin G to a 2-weeks course of intravenous penicillin.

Case presentation:

A 53 years old male, presented for fever and abdominal pain, was found on physical examination to have a macular rash on the palms and soles, with fever and abdominal tenderness.

Laboratory findings revealed AST 199 IU/L, ALT 132 IU/L, positive RPR, FTA-ABS and HIV antibodies test and a high HIV viral load.

He was diagnosed with secondary syphilis and HIV co-infection. His hepatitis did not improve after intramuscular injection of penicillin G, his symptoms continued to worsen. A liver biopsy was done and revealed acute hepatitis and canalicular cholestasis, without evidence of treponemes.

Patient was started on intravenous penicillin. He showed significant clinical improvement, and his LFT normalized.

Conclusion:

This case describes severe syphilitic hepatitis with unusual cytolytic disturbance of the liver function that failed to improve with one intramuscular penicillin injection. It demonstrates the need of intravenous penicillin therapy to achieve adequate clinical response, particularly in patients with severe laboratory evidence of liver inflammation.