obsolete secondary syphilitic hepatitis

Obsolete Secondary Syphilitic Hepatitis

Secondary syphilitic hepatitis, also known as hepatic lesions in secondary syphilis, is a rare manifestation of the disease that involves infection of the liver by the spirochete Treponema pallidum. This condition typically occurs during the secondary stage of syphilis, which usually appears 2 to 6 months after the initial infection.

Characteristics

• Hepatic lesions are formed due to the spread of numerous viable spirochetes during this stage of disease [4].
• The liver involvement is very rarely seen and occurs in the second phase of the disease [14].
• Syphilitic hepatitis generally is a mild clinical condition, characterized by high serum alkaline phosphatase level, often with normal or only slightly abnormal transaminases [14].

Symptoms

• Hepatosplenomegaly (enlargement of the liver and spleen) may be present in some cases.
• Jaundice (yellowing of the skin and eyes) can occur due to liver dysfunction.

Diagnosis

• A provisional diagnosis of secondary syphilis with syphilitic hepatitis was made based on clinical presentation, laboratory criteria, and liver biopsy findings [10].
• Liver biopsy may show maintained hepatic architecture with Kupffer cell hyperplasia, lymphocytic and neutrophillic infiltration of portal tracts, and mild neutrophillic infiltrate in the liver tissue [10].

Treatment

• Penicillin is the first-line treatment for syphilis, and response to therapy is one of the diagnostic criteria [12].
• Early diagnosis and timely treatment are essential to prevent complications and improve patient outcomes.

Based on the provided context, it appears that secondary syphilitic hepatitis is a rare manifestation of syphilis, and its presentation can be nonspecific.

Common manifestations of secondary syphilis:

• Mucocutaneous lesions that are macular, maculopapular, papulosquamous, or pustular [6]
• Rash involving the hands, soles, or any other body part (78%) [13]

Other signs and symptoms:

• Jaundice and a nonpruritic rash with multiple erythematous and nonconfluent maculopapular lesions, concentrated on the trunk, palms, and soles [1][3]
• Fatigue/poor appetite (57%) [2]
• Icterus (jaundice) [2]

Rare manifestations:

• Hepatitis with abnormal liver function tests and prominent elevation in alkaline phosphatase levels [10]
• Symptoms or signs of central nervous system involvement, including meningismus, meningitis, headaches, and mental changes; cranial nerve abnormalities such as ocular palsy, deafness, or nystagmus, and internuclear ophthalmoplegia; cerebrovascular accidents [11]

It's essential to note that these manifestations can be nonspecific and may not necessarily indicate secondary syphilitic hepatitis. A proper diagnosis should be made by a healthcare professional based on a thorough medical evaluation.

References: [1] Kern C (2020) - The most common signs are jaundice and a nonpruritic rash with multiple erythematous and nonconfluent maculopapular lesions, concentrated on the trunk, palms, and soles. [2] Alemam A (2021) - in 2018 demonstrated that the most common clinical manifestations of syphilitic hepatitis were rash (78%), fatigue/poor appetite (57%), icterus... [3] Kern C (2020) - The most common signs are jaundice and a nonpruritic rash with multiple erythematous and nonconfluent maculopapular lesions, concentrated on the trunk, palms, and soles. [6] Secondary syphilis presents with systemic symptoms weeks to months after the initial inoculation, with a rash most commonly involving the hands... [10] Our patient presented with signs and symptoms of hepatitis with abnormal liver function tests and prominent elevation in alkaline phosphatase levels. An initial diagnosis of alcohol or a non-hepatotropic virus causing hepatitis was made. [11] However, no more than 6% of cases develop during late stages, and the most frequently occurring signs and symptoms in patients with syphilitic hepatitis are rashes involving the palms of both hands, soles, or any other body part (78%), followed by...

Diagnostic Tests for Obsolete Secondary Syphilitic Hepatitis

Syphilitic hepatitis, a rare manifestation of secondary syphilis, can be challenging to diagnose due to its nonspecific presentation. However, several diagnostic tests can help confirm the diagnosis.

• Venereal Disease Research Laboratory (VDRL) test: This is a traditional serological test used to detect antibodies against Treponema pallidum, the bacterium that causes syphilis. A positive VDRL result, along with clinical symptoms and liver enzyme abnormalities, can support the diagnosis of syphilitic hepatitis [8].
• Treponema pallidum haemagglutination (TPHA) test: This test is another serological assay used to detect antibodies against T. pallidum. A positive TPHA result, in conjunction with clinical findings and liver enzyme elevations, can help confirm the diagnosis of syphilitic hepatitis [9].
• Liver biopsy: While not always necessary for diagnosis, liver biopsy can provide histopathological evidence of syphilitic hepatitis. The presence of characteristic lesions, such as Kupffer cell hyperplasia and lymphocytic infiltration, can support the diagnosis [12].

Important Considerations

When diagnosing syphilitic hepatitis, it is essential to consider other potential causes of liver enzyme abnormalities, such as autoimmune hepatitis or viral hepatitis. A thorough medical history, physical examination, and laboratory tests are necessary to rule out these alternative diagnoses.

In addition, prozone phenomenon, a rare false-negative reaction, can occur in certain cases of syphilis. This phenomenon is more common in patients with HIV or neurosyphilis [15].

References

• [8]
• [9]
• [12]
• [15]

Treatment Options for Obsolete Secondary Syphilitic Hepatitis

Obsolete secondary syphilitic hepatitis, a rare complication of syphilis, requires prompt and effective treatment to prevent further liver damage. Based on the available information, the following drug treatments are recommended:

• Penicillin G benzathine: This is the standard treatment for syphilis and its complications, including obsolete secondary syphilitic hepatitis [1][4]. A single dose of penicillin G benzathine is often effective in treating this condition.
• Doxycycline or macrolides: In cases where patients are allergic to beta-lactams, doxycycline or macrolides can be used as alternative treatments for obsolete secondary syphilitic hepatitis [4].

It's essential to note that the treatment response is defined by a significant improvement in liver function and a reduction in symptoms [8]. In severe cases, fulminant liver failure may occur, requiring immediate medical attention.

References:

[1] Context 1: A single dose of penicillin G benzathine is the standart treatment for SH. [4] Context 4: The treatment of syphilitic hepatitis consists of administration of penicillin G benzathine, or doxycycline or macrolides in the case of allergy to beta-lactams. [8] Context 8: For syphilitic hepatitis, treatment response is defined as a ...

Differential Diagnosis of Obsolete Secondary Syphilitic Hepatitis

Secondary syphilitic hepatitis, a rare manifestation of syphilis, can be challenging to diagnose due to its similarity with other liver conditions. The differential diagnosis for obsolete secondary syphilitic hepatitis includes:

• Autoimmune hepatitis: This is the most commonly reported etiology, accounting for 40% of cases [5].
• Drug-induced liver injury (DILI): Secondary to allopurinol or other medications, which can cause abnormal liver enzyme levels and serologic evidence for syphilis [1][3][6].
• Herbal remedies: Certain herbal products have been linked to liver damage and may be considered in the differential diagnosis [5].
• Primary biliary cholangitis (PBC): A progressive autoimmune disease that can cause liver injury, but is less commonly associated with syphilis hepatitis [9].

Key Diagnostic Features

To consider secondary syphilitic hepatitis in the differential diagnosis, the following features should be present:

• Abnormal liver enzyme levels, particularly increased alkaline phosphatase
• Serologic evidence for syphilis (RPR and VDRL tests are uniformly positive)
• Rashes involving palms and soles [10]
• Elevated levels of liver enzymes that improve with antibiotic treatment for secondary syphilis [11]

Clinical Considerations

In patients with abnormal liver enzyme levels, especially increased alkaline phosphatase, and rashes involving palms and soles, syphilitic hepatitis should be included in the early differential diagnosis. A provisional diagnosis can be made based on clinical presentation, serologic evidence, and liver biopsy findings [14].

References:

[1] Alemam et al. (2021) - Cited by 11 [3] Alemam et al. (2021) - Cited by 11 [5] Mulder et al. (2015) - Cited by 12 [6] Alemam et al. (2021) - Cited by 11 [9] Kern et al. (2020) - Cited by 7 [10] Kern et al. (2020) - Cited by 7 [11] da Silva et al. - Cited by 3 [14] Alemam et al. (2021) - Cited by 11