TBA (24S175)

Syphilitic Hepatitis: An uncommon hepatic presentation of Treponema Pallidum

Author(s)

S. Hunter, H. Ulaganathan, S. Sengupta

Department(s)/Institutions

Department of Gastroenterology and Hepatology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth

Introduction

Syphilitic hepatitis, recognised in 1585 and reported by Harn in 1943, is a rare consequence of Treponema pallidum. It’s defined as a cholestatic liver enzymes with serological evidence of syphilis, in the absence of other causes of hepatic dysfunction and improvement after appropriate therapy. Estimated incidence is between 0.2%-38% in syphilis diagnosed patients.

Aims/Background

A 41-year-old man who was initially diagnosed with a migraine and discharged on propranolol and amitriptyline. He later exhibited erythematous pruritic rash with neck swelling, chills and new liver enzyme derangement (ALP 243, GGT 156, ALT 84). Despite suspicion of drug induced liver injury, liver enzymes worsened despite cessation of medications (ALP 1052, GGT 541, ALT 325) alongside new symptoms; oro-genital ulcers and blurred vision.

Method

A serological liver screen, imaging and a liver biopsy were performed alongside a comprehensive STI screen.

Results

Liver screen revealed a positive CMV IgG and positive IgM (Architect) but negative CMV IgM (Vidas) reflecting possible seroconversion. Ultrasound and MRCP showed no ductal abnormality. Liver biopsy showed moderate periportal and lobular inflammation with eosinophils. Serological testing was positive for Treponema pallidum. He was diagnosed with neurosyphilis with ocular involvement with syphilitic hepatitis. His liver function resolved with 2 weeks of IV benzylpenicillin and prednisolone.

Conclusions

Syphilitic hepatitis represents a rare but important consideration in patients with unexplained liver chemistries. Early recognition and treatment are crucial to allow liver function restoration but also prevent unnecessary investigations and complications. This case underscores the significance of maintaining vigilance for uncommon infectious aetiologies in hepatic pathologies.