A Case of Syphilitic Hepatitis in an HIV-Infected Patient

Publication date: Available online 2 March 2018
Source:Human Pathology
Author(s): Margarita N. German, Kristina A. Matkowskyj, Robert J. Hoffman, Parul D. Agarwal
While the incidence of syphilis has been persistently on the rise in the United States, hepatitis as a complication of early syphilis is relatively uncommon. We present a case of a 51-year-old homosexual, HIV-positive male who presented with acute cholestatic hepatitis with a predominantly elevated alkaline phosphatase. After lab studies and imaging were unrevealing, a liver biopsy was performed that showed expanded portal tracts with a predominantly lymphoplasmacytic infiltrate and prominent bile ductular proliferation with periductal neutrophils. Testing revealed a positive rapid plasma reagin and a subsequent Warthin-Starry stain of the liver tissue demonstrated the presence of scattered spirochetes, confirmed as Treponema pallidum spirochetes on immunohistochemistry testing. These findings confirmed a diagnosis of syphilitic hepatitis. With therapy, symptoms and liver enzymes rapidly normalized. Given the persistent rise in syphilis incidence along with the morbidity and mortality associated with a missed diagnosis, keen suspicion, early identification and treatment is crucial.



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