[Syphilis hepatitis and liver transplantation]

Area of Science:

• Hepatology
• Infectious Diseases
• Transplantation Immunology

Background:

• Secondary syphilis hepatitis is an uncommon manifestation of syphilis.
• Liver transplantation (LT) patients are immunocompromised, potentially altering disease presentation.
• The diagnosis and management of syphilis in LT recipients require careful consideration.

Observation:

• A homosexual male, 15 years post-orthotopic liver transplantation, presented with rash, mild liver enzyme elevation, and cholestasis.
• Syphilis serology revealed high titers for VDRL, TPHA, and positive IgM FTA-abs.
• Liver biopsy showed low-grade hepatitis (A1F1) with portal inflammation, but no cholestasis.

Findings:

• The patient received benzathine penicillin, with a temporary increase in prednisolone.
• Rapid resolution of cytolysis and progressive disappearance of cholestasis were observed.
• IgM FTA-abs normalized, while VDRL and TPHA titers showed a slight decrease.

Implications:

• This case highlights secondary syphilis hepatitis as a treatable cause of liver dysfunction in post-LT patients.
• Early diagnosis and appropriate antibiotic therapy are crucial for managing syphilis in this population.
• Monitoring serological markers is important for assessing treatment response in immunocompromised individuals.