Intrahepatic cholestasis due to Treponema pallidum in an immunocompetent patient
Abstract
Hepatitis due to Treponema pallidum is a rare entity and its diagnosis represents a clinical challenge. Treponema pallidum should be considered as a presumptive etiology in all patients with acute liver disease, when other frequent causes have been ruled out.
We present the case of a young, immunocompetent patient with elevated values in his liver tests, a cholestatic pattern, and maculopapular lesions on his palms and soles. Given his clinical picture, diagnostic tests, and response to the antimicrobial therapy, a diagnosis of cholestasis due to secondary syphilis has been established. It is important to include secondary syphilis within the possible causes of acute liver disease.
Downloads
References
Ghanem KG, Ram S, Rice PA. The Modern Epidemic of Syphilis. N Engl J Med. 2020;382:845–54. https://doi.org/10.1056/NEJMra1901593
Narang N, Al-Jashaami L, Patel N. Spirochetes in the liver: An unusual presentation of a common STI. Case Rep Med. 2019;20191012405. https://doi.org/10.1155/2019/1012405
Alemam A, Ata S, Shaikh D, Leuzzi B, Makker J. Syphilitic hepatitis: A rare cause of acute liver injury. Cureus. 2021;13:e14800. https://doi.org/10.7759/cureus.14800
Valeria Y, Cuero D, Diaz Cuero YV, Cagigas AV. Sífilis secundaria: reporte de 2 casos. Secondary syphilis: 2 cases’ report. Rev Asoc Colomb Dermatol. 2019;27:143-6.
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance, 2021. Fecha de consulta: 11 de abril de 2023. Disponible en: https://www.cdc.gov/std/statistics/2021/default.htm
Cardona-Arias JA, Higuita-Gutiérrez LF, Cataño-Correa JC. Prevalencia de infección por Treponema pallidum en individuos atendidos en un centro especializado de Medellín, Colombia. Rev Fac Nac Salud Pública. 2022;40:e343212. https://doi.org/10.17533/udea.rfnsp.e343212
Al Dallal HA, Narayanan S, Alley HF, Eiswerth MJ, Arnold FW, Martin BA, et al. Case report: syphilitic hepatitis-a rare and underrecognized etiology of liver disease with potential for misdiagnosis. Front Med (Lausanne). 2021;8:789250. https://doi.org/10.3389/fmed.2021.789250
del Romero J, García-Pérez JN, Espasa-Soley M. Prevención y tratamiento de las infecciones de transmisión sexual en personas con alto riesgo, incluyendo pacientes infectados por el VIH. Enferm Infecc Microbiol Clin. 2019;37:117-26. https://doi.org/10.1016/j.eimc.2018.11.008
Fuertes A. Diagnostico serológico de la sífilis. Control de calidad SEIMC. 1997. Fecha de consulta: 11 de abril de 2023. Disponible en: https://www.seimc.org/contenidos/ccs/revisionestematicas/serologia/sifilis2.pdf
Horn CL, Jalali S, Abbott J, Stein MT. A surprising diagnosis: syphilitic gastritis and hepatitis. Am J Med. 2018;131:1178–81. https://doi.org/10.1016/j.amjmed.2018.03.023
Kim GH, Kim BU, Lee JH, Choi YH, Chae HB, Park SM, et al. Cholestatic hepatitis and thrombocytosis in a secondary syphilis patient. J Korean Med Sci. 2010;25:1661. https://doi.org/10.3346/jkms.2010.25.11.1661
Hussain N, Igbinedion SO, Diaz R, Alexander JS, Boktor M, Knowles K. Liver cholestasis secondary to syphilis in an immunocompetent patient. Case Reports Hepatol. 2018;2018:8645068. https://doi.org/10.1155/2018/8645068
García de Paredes A, Villajos LT, Castro A, de Santiago R, et al. Hepatitis aguda como única manifestación de sífilis en un paciente inmunocompetente. Acta Gastroenterol Latinoam. 2015;45:230–2.
Mullick CJ, Liappis AP, Benator DA, Roberts AD, Parenti DM, Simon GL. Syphilitic hepatitis in HIV-infected patients: A report of 7 cases and review of the literature. Clin Infect Dis. 2004;39:e100–5. https://doi.org/10.1086/425501
Greenstone CL, Saint S, Moseley RH. A hand-carried diagnosis. N Engl J Med. 2007;356:2407-11. https://doi.org/10.1056/NEJMcps062271
Huang J, Lin S, Wan B, Zhu Y. A systematic literature review of syphilitic hepatitis in adults. J Clin Transl Hepatol. 2018;6:306–9. https://doi.org/10.14218/JCTH.2018.00003
Some similar items:
- Gladys Pinilla, Lesly Campos, Andrea Durán, Jeannette Navarrete, Liliana Muñoz, Detection of Treponema pallidum subspecies pallidum for the diagnosis of congenital syphilis by nested polymerase chain reaction , Biomedica: Vol. 38 No. 1 (2018)
- Juan Carlos Martínez-Garcés, Michael Macías-Vidal, Ronald Maestre-Serrano, Ricardo Ávila-De la Hoz, Eduardo Navarro-Jiménez, Johan Bula-Viecco, Lisbeth Ricaurte-Barrera, Seroreactivity and prevalence of syphilis in donors at a blood bank in Barranquilla, Colombia , Biomedica: Vol. 39 No. Sp. 1 (2019): Suplemento 1, Microbiología médica, mayo
- Beatriz E. Orozco-Sebá, Diego Viasus, Esperanza Meléndez, Jairo Fuentes, José Tovar, Elkin A. Amado, Daniela Loaiza, Orozco-Sebá BE, Viasus D, Meléndez E, Fuentes J, Tovar J, Amado EA, et al. Colestasis intrahepática por Treponema pallidum en paciente inmunocompetente. Biomedica. 2023;43:164-70. , Biomedica: Vol. 44 No. 2 (2024)
Copyright (c) 2023 Biomedica
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
