J Korean Med Sci.  2010 Nov;25(11):1661-1664. 10.3346/jkms.2010.25.11.1661.

Cholestatic Hepatitis and Thrombocytosis in a Secondary Syphilis Patient

• Kim GH
• Kim BU
• Lee JH
• Choi YH
• Chae HB
• Park SM
• Youn SJ
• Lee JY
• Yoon TY
• Sung R

• KMID: 1779239
• DOI: http://doi.org/10.3346/jkms.2010.25.11.1661

Abstract

The incidence of acute hepatitis in syphilis patient is rare. First of all, our patient presented with hepatitis comorbid with thrombocytosis. To our knowledge, this is only the second report of syphilitic hepatitis with thrombocytosis. The 42-yr-old male complained of flulike symptoms and skin eruptions on his palms and soles. Laboratory findings suggested an acute hepatitis and thrombocytosis. Serologic test results were positive for VDRL. He recovered from his symptoms and elevated liver related enzymes with treatment. Because syphilitic hepatitis can present without any typical signs of accompanying syphilis, syphilis should be considered as a possible cause in acute hepatitis patients.

Keyword

Hepatitis; Syphilis, Cutaneous; Thrombocytosis

MeSH Terms

Acute Disease
Adult
Alkaline Phosphatase/blood
Bilirubin/blood
Epidermis/pathology
Hepatitis/*diagnosis/etiology/pathology
Humans
Jaundice
Male
Penicillin G Benzathine/therapeutic use
Syphilis/*complications
Syphilis Serodiagnosis
Thrombocytosis/*etiology
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Photographic findings of syphilid. There are multiple erythematous macules and flat-topped papules with scales on both palms (A), soles (B), and the trunk (C).

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  Fig. 2 Computed tomographic findings. (A) Horizontal, (B) Coronal section. They show no dilatation of the intrahepatic and extrahepatic bile ducts, but the gall bladder wall was thickened.

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  Fig. 3 Findings of tissue biopsy findings. (A) Liver. Stromal edema is observed around the portal tract. Both focal necrosis and infiltration of lymphocytes, eosinophils and neutrophils in the lobule are also observed (periodic acid-Schiff stain, ×200). (B) Skin. The epidermis shows parakeratosis, acanthosis with elongation of rete ridges, and exocytosis of lymphocytes. A dense perivascular inflammatory infiltrate is seen in A the dermis (H&E, ×100).

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  Fig. 4 Clinical course after the treatment. The serum level of total bilirubin and alkaline phosphatase has significantly declined after the benzathine penicillin treatment. ALP, alkaline phosphatase.

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