Richardson Kimberly J, Yen George C
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA) Health, Los Angeles, USA.
Cureus. 2024 Nov 26;16(11):e74524. doi: 10.7759/cureus.74524. eCollection 2024 Nov.
Syphilitic hepatitis is a rare manifestation of a sexually transmitted infection. Given its nonspecific presentation, it is important for clinicians to consider the diagnosis in sexually active patients presenting with elevated liver tests. In this case, a 30-year-old man presented with an itchy rash and was diagnosed with an allergic reaction. He returned to the clinic one week later with a worsening rash. A sexual history was obtained, which led to sexually transmitted disease testing. Laboratory evaluation revealed a positive syphilis serology. A diagnosis of secondary syphilis was made, and he was treated with penicillin. The following day, he presented to the emergency department complaining of worsening rash, abdominal pain, and fever. Laboratory evaluation was significant for elevated transaminases. He received supportive care and was advised to follow up with his primary care provider. One month after his initial presentation, he presented to the clinic with resolution of the rash. Laboratory evaluation revealed a fourfold decrease in rapid plasma reagin titer and improvement in liver enzymes. The transaminitis work-up was unremarkable, and the liver tests ultimately normalized. A diagnosis of syphilitic hepatitis was made. A comprehensive detailed sexual history is important and key to the diagnosis of syphilitic hepatitis. Long-term sequelae are rare. Syphilitic hepatitis is a curable condition and should remain in the differential diagnosis in all sexually active persons presenting with abnormal liver enzymes.
梅毒肝炎是一种性传播感染的罕见表现。鉴于其非特异性表现，临床医生在面对肝功能检查结果升高的性活跃患者时考虑该诊断非常重要。在本病例中，一名30岁男性出现瘙痒性皮疹，最初被诊断为过敏反应。一周后他因皮疹加重返回诊所。获取性病史后进行了性传播疾病检测。实验室检查显示梅毒血清学呈阳性。诊断为二期梅毒，给予青霉素治疗。次日，他因皮疹加重、腹痛和发热前往急诊科就诊。实验室检查显示转氨酶升高。他接受了支持性治疗，并被建议随访其初级保健医生。首次就诊一个月后，他因皮疹消退返回诊所。实验室检查显示快速血浆反应素滴度下降四倍，肝功能酶有所改善。转氨酶检查无异常，肝功能检查最终恢复正常。诊断为梅毒肝炎。全面详细的性病史对于梅毒肝炎的诊断很重要且关键。长期后遗症罕见。梅毒肝炎是可治愈的疾病，对于所有肝功能酶异常的性活跃者都应将其列入鉴别诊断。
