梅毒性肝炎非典型病例。

Atypical case of syphilitic hepatitis.

作者信息

Goldberg Elliott, Edwards Bathai, Krill Kaleigh

机构信息

Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA

Internal Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.

出版信息

BMJ Case Rep. 2021 Mar 17;14(3):e237851. doi: 10.1136/bcr-2020-237851.

DOI:10.1136/bcr-2020-237851

PMID:33731401

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7978060/

Abstract

A 31-year-old immunocompetent, heterosexual man with no relevant medical history presented with 1 week of jaundice, abdominal pain, cough and headache. Examination revealed scleral icterus, right upper quadrant tenderness and hepatomegaly. Initial investigations revealed hyperbilirubinaemia and elevated transaminases. Serum studies were positive for antinuclear antibodies, antimitochondrial antibodies, and herpes simplex virus IgM. Despite being started on intravenous acyclovir, his bilirubin and transaminase levels continued to rise. He was subsequently tested for syphilis given his maculopapular rash on the soles of his feet and it returned positive. He improved clinically with the initiation of penicillin. In this case, we will discuss the presentation, diagnosis and treatment of syphilitic hepatitis.

摘要

一名31岁免疫功能正常的异性恋男性，无相关病史，出现黄疸、腹痛、咳嗽和头痛1周。检查发现巩膜黄疸、右上腹压痛和肝肿大。初步检查显示高胆红素血症和转氨酶升高。血清学检查抗核抗体、抗线粒体抗体和单纯疱疹病毒IgM呈阳性。尽管开始静脉注射阿昔洛韦治疗，但其胆红素和转氨酶水平仍持续升高。鉴于其足底出现斑丘疹，随后对其进行了梅毒检测，结果呈阳性。使用青霉素治疗后，他的临床症状有所改善。在本病例中，我们将讨论梅毒性肝炎的临床表现、诊断和治疗。