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This case highlights secondary syphilis as a rare cause of severe acute hepatitis, even without typical skin symptoms. Early syphilis testing is crucial for diagnosing this often-overlooked liver disease.

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Area of Science:

  • Hepatology
  • Infectious Diseases
  • Syphilology

Background:

  • Secondary syphilis is a systemic infection that can manifest with diverse clinical presentations.
  • Hepatic involvement in syphilis, known as syphilitic hepatitis, is uncommon and typically presents with mild liver enzyme elevations.

Observation:

  • A 23-year-old patient presented with severe hepatic cytolysis (ASAT: 18N; ALAT: 44N), jaundice, and mucocutaneous signs.
  • Initial investigations for toxic, viral, and autoimmune hepatitis were negative.
  • Cutaneous manifestations appearing three weeks after hepatic symptoms prompted syphilis testing, which was positive.

Findings:

  • This case describes unusually high transaminase levels in syphilitic hepatitis, exceeding those in previously reported instances.
  • Syphilitic hepatitis is a rare complication, occurring in less than 10% of syphilis cases.
  • The diagnosis was confirmed as secondary syphilis presenting as acute hepatitis.

Implications:

  • Syphilis should be considered in the differential diagnosis of acute hepatitis, particularly in patients with suggestive infectious symptoms.
  • This case underscores the importance of considering syphilis as a potential cause of severe hepatitis, even when classic dermatological signs are absent.
  • Early diagnosis and treatment of syphilitic hepatitis are essential to prevent potential liver damage and systemic complications.