Cunha Neves João A, Roseira Joana, Tavares de Sousa Helena, Machado Rui
Department of Gastroenterology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal.
Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
GE Port J Gastroenterol. 2021 Jun 16;29(4):280-283. doi: 10.1159/000516944. eCollection 2022 Jul.
Syphilis is a chronic infection caused by . Manifestations of this disease are vast, and syphilitic hepatitis is a rarely depicted form of secondary syphilis.
We report the case of a 63-year-old man with worsening jaundice, maculopapular rash and perianal discomfort. Proctological examination with anoscopy revealed a perianal gray/white area with millimetric pale granules along the anal canal. Liver function tests showed a mixed pattern. Venereal Disease Research Laboratory, hemagglutination assay and IgM fluorescent treponemal antibody absorbance were positive. The patient was successfully treated with a single dose of penicillin G.
DISCUSSION/CONCLUSION: Syphilitic hepatitis is scarcely reported in the literature. Secondary syphilis with mild hepatitis rarely leads to hepatic cytolysis and jaundice. Many signs of secondary syphilis including syphilitic hepatitis may be linked to immune responses initiated during early infection. Over the past decades, evidence has emerged on the importance of innate and adaptive cellular immune responses in the immunopathogenesis of syphilis. This report raises awareness to a clinical entity that should be considered in patients at risk for sexually transmitted diseases, who present with intestinal discomfort or liver dysfunction, as it is a treatable and fully reversible condition.
梅毒是一种由……引起的慢性感染。这种疾病的表现多种多样，而梅毒性肝炎是二期梅毒中一种较少被描述的形式。
我们报告了一名63岁男性的病例，他出现黄疸加重、斑丘疹和肛周不适。通过肛门镜进行的直肠检查发现肛管处有一个肛周灰白色区域，伴有毫米级的苍白颗粒。肝功能检查显示为混合模式。性病研究实验室试验、血凝试验和IgM荧光密螺旋体抗体吸收试验均为阳性。该患者通过单剂量青霉素G成功治愈。
讨论/结论：梅毒性肝炎在文献中报道较少。伴有轻度肝炎的二期梅毒很少导致肝细胞溶解和黄疸。包括梅毒性肝炎在内的许多二期梅毒体征可能与早期感染期间引发的免疫反应有关。在过去几十年中，关于先天性和适应性细胞免疫反应在梅毒免疫发病机制中的重要性已有证据出现。本报告提高了对一种临床实体的认识，对于有性传播疾病风险、出现肠道不适或肝功能障碍的患者应考虑到这一实体，因为它是一种可治疗且完全可逆的病症。
