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[Hypersensitive reaction to abacavir or syphilitic hepatitis?]
Hélène Dumouchel-Champagne1, Damien Bouhour, Tristan Ferry
1Service de médecine interne et des maladies infectieuses, Hôpital de Fleyriat, Bourg-en-Bresse.
Presse Medicale (Paris, France : 1983)
|October 25, 2003
Summary
Syphilis can present as hepatitis and rash, mimicking drug reactions in HIV patients. Early diagnosis with penicillin treatment is crucial for recovery.
Area of Science:
- Infectious Diseases
- Hepatology
- Dermatology
Background:
- Syphilis is a growing concern in France, with increasing cases linked to high-risk sexual behaviors.
- Human Immunodeficiency Virus (HIV) infection is a significant co-morbidity often managed with combination antiretroviral therapy.
Observation:
- A case of an HIV-positive homosexual male presenting with abnormal liver function tests and a roseola-like rash.
- Symptoms emerged 15 days after initiating Trizivir, initially suggesting a hypersensitivity reaction to abacavir.
- Discontinuation of Trizivir did not resolve the symptoms, prompting further investigation.
Findings:
- The patient was diagnosed with syphilitic hepatitis and roseola.
- Diagnosis was confirmed by seroconversion for syphilis.
- Treatment with benzathine penicillin led to symptom resolution.
- Trizivir was successfully reintroduced without adverse effects.
Implications:
- This case highlights the importance of considering syphilis in patients with unexplained hepatitis and cutaneous manifestations, even those on antiretroviral therapy.
- Syphilitic hepatitis can mimic drug-induced liver injury, necessitating a thorough diagnostic workup.
- Penicillin remains the gold standard treatment for syphilis, and successful co-treatment with antiretrovirals is possible.