Pereira Flávio G, Leal Mariana S, Meireles Daniela, Cavadas Susana
Internal Medicine Service, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
Gastroenterol Hepatol Bed Bench. 2021 Winter;14(1):77-80.
Syphilis is a sexual transmitted disease caused by and an underdiagnosed and underreported cause of acute hepatitis. In recent years, reported cases of primary and secondary syphilis have been increasing, mostly in men who have sex with men. Clinical manifestations of syphilis are diverse, earning the name of "the great imitator" which can affect virtually any organ. Nonetheless, hepatic involvement is rare, but it can occur at any stage of the disease. We present the case of a 41-year-old immunocompetent male, that presents to us with a cholestatic hepatitis and a diffuse erythematous rash with palmo-plantar affection. The patient had no history of primary syphilis. After throughout aetiologic study, he was diagnosed with syphilitic hepatitis and treated with intramuscular Benzathine benzylpenicillin, with the disappearance of the rash and normalization of liver enzymes after 3 months. We would like to highlight that this aetiology should be considered in patients with unexplained elevation of liver enzymes (mainly cholestatic enzymes) and an epidemiologic context of unsafe sexual exposure.
梅毒是一种由性传播的疾病，也是急性肝炎诊断不足和报告不足的病因。近年来，一期和二期梅毒的报告病例一直在增加，主要发生在男男性行为者中。梅毒的临床表现多种多样，素有“模仿大师”之称，几乎可累及任何器官。尽管如此，肝脏受累情况罕见，但可发生于疾病的任何阶段。我们报告一例41岁免疫功能正常男性病例，该患者因胆汁淤积性肝炎和伴有掌跖受累的弥漫性红斑皮疹前来就诊。患者无一期梅毒病史。经过全面的病因学研究，他被诊断为梅毒性肝炎，并接受了肌肉注射苄星青霉素治疗，3个月后皮疹消失，肝酶恢复正常。我们想强调的是，对于不明原因肝酶升高（主要是胆汁淤积酶）且有不安全的性接触流行病学背景的患者，应考虑这一病因。
