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• W2912773985 abstract "Clinicians frequently encounter abnormal liver chemistries in both the hospital and outpatient medical settings. Due to a wide array of potential causes, determining the etiology of hepatic dysfunction can be a diagnostic challenge. Although syphilis is an uncommon cause of clinical hepatitis, it should be considered in the differential diagnosis of these patients. A 37-year-old African American man with a history of type I diabetes and sickle cell trait was referred for jaundice. He presented with right upper quadrant (RUQ) abdominal pain for ten days and elevated liver chemistries with a total bilirubin (TB) of 11.4, alanine aminotransferase (ALT) of 59, aspartate aminotransferase (AST) of 39, and alkaline phosphatase (ALP) of 657. His viral hepatitis panel was negative and he denied the use of alcohol or hepatotoxic drugs. Physical exam revealed scleral icterus and RUQ abdominal tenderness. Abdominal ultrasound showed mild hepatic fatty infiltration without biliary obstruction or stones. Both CT scan of the abdomen and MRCP were negative for biliary or pancreatic ductal dilation. Metabolic liver disease work up was negative. Hemolysis labs including lactate dehydrogenase and haptoglobin were within normal limits and there was absence of sickling on peripheral blood smear. RPR returned positive with a reflex titer of 1:64. Treponema pallidum IgG was checked for confirmation and was reactive. Liver biopsy showed chronic hepatitis with normal hepatic architecture, Kupffer cell hyperplasia, hepatic cholestasis and ductal proliferation suggestive of syphilitic hepatitis. The patient was given penicillin G 2.4 million units IM once for treatment. Two weeks later, liver chemistries improved to TB of 1.7, ALT of 45, AST of 39 and ALP of 298 with resolution of abdominal pain. Liver involvement is a unique and often unrecognized manifestation of early syphilis. Its diagnosis is suggested by elevated liver chemistries, positive syphilis serology and resolution of symptoms and biochemical abnormalities following antimicrobial treatment. Pericholangiolar inflammation may cause a cholestatic picture and disproportional elevation in serum ALP levels, as seen in this patient. Due to the rapid reversibility with penicillin G treatment, it is important to consider syphilis in the differential diagnosis of hepatitis.Figure: Liver biopsy Moderate canalicular cholestasis. H&E stain high power (400x).Figure: Liver biopsy with eosinophil and cholestasis. The white lines indicate cholestasis and bile plugging. The yellow arrow indicates an eosinophil. H&E stain High power (400x)." @default.
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• W2912773985 date "2017-10-01" @default.
• W2912773985 modified "2023-10-18" @default.
• W2912773985 title "Liver Cholestasis Secondary to Syphilis in an Immunocompetent Patient: 2017 Presidential Poster Award" @default.
• W2912773985 doi "https://doi.org/10.14309/00000434-201710001-02343" @default.
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