Secondary Syphilis Presenting as Fulminant Hepatic Failure: A Case Report and Literature Review

Syphilis has afflicted humanity for centuries, and despite advances in prevention and treatment, its prevalence continues to rise. Certain forms of the disease remain underreported, contributing to an incomplete understanding of their presentations. This report details the case of a 20-year-old female who developed fulminant hepatic failure (FHF) associated with active secondary syphilis. Despite receiving penicillin treatment, she required a liver transplant. To raise awareness in the medical community, the authors also review similar cases from the literature. Notably, only two other reports of FHF linked to secondary syphilis in adults exist, highlighting the limited experience with this presentation. All three cases shared similar clinical features, and each patient met the criteria for placement on the liver transplant waiting list. Given the rising incidence and diverse manifestations of syphilis, Treponema pallidum infection should be considered a potential cause of acute liver failure in sexually active patients. The similarities among these cases suggest a recognizable pattern of signs and symptoms, underscoring the importance of early referral to a transplant center.