Liver involvement in HIV-infected patients diagnosed with syphilis

Prevalence of Syphilitic Hepatitis Among HIV-Infected Patients in Istanbul, Turkey, a Region with an Increasing Incidence of Syphilis and HIV Infection

Background: Syphilis is a global health issue, which continues to occur at high rates worldwide, particularly in HIV-infected men, who have sex with men (MSM). Hepatitis can present as an uncommon manifestation of syphilis, and the diagnosis may be overlooked in favor of more common causes of liver injury in this group. Objectives: This study aimed to determine the prevalence and risk factors of syphilitic hepatitis among HIV-infected individuals diagnosed with acute syphilis. Methods: This cross-sectional study was conducted on HIV-infected individuals who regularly attended a tertiary clinic in Istanbul. The data were collected and analyzed between 2016 and 2019. Cases of syphilitic hepatitis were included according to the following criteria: (I) VDRL-confirmed Treponema pallidum infection after or simultaneously diagnosed with HIV infection; (II) elevated liver enzymes, including ALT, AST, and ALP, that resolved after penicillin treatment; and (III) exclusion of other causes of hepatitis. Sociodemographic characteristics of the participants, clinical and laboratory findings were evaluated using medical records. Results: Among 1,057 HIV-infected patients, 141 (13.3%) were diagnosed to have an early stage of syphilis, 138 of them were male. Nine (6.4 %) out of 141 patients had syphilitic hepatitis, and all of them were self-identified MSM. Moreover, 5 out of these 9 patients were simultaneously diagnosed with syphilis and HIV infection. Up to 10-fold increase in ALT/AST was noted in all of them, and a 3.5-fold increase in bilirubin was observed in two cases. The most prominent laboratory abnormalities in syphilitic hepatitis patients were the detection of a considerable increase in ALP and HIV RNA levels. Conclusions: Syphilitic hepatitis is not encountered rarely in HIV-infected individuals, predominantly MSM populations. Since HIV/syphilis coinfected patients are more infective as a result of higher HIV RNA levels, early diagnosis, and treatment are crucial.

Cholangitis and pulmonary nodules in a clinical presentation of syphilis in an HIV-infected patient

Several clinical manifestations attributed to syphilitic infection have been described in the literature. This is important because of the increased incidence of this infection mainly among men who have sex with men. We report the case of an HIV-infected patient who was hospitalized due to severe cholestasis, initially interpreted as drug-induced liver disease. It evolved slowly, with increasing intrahepatic cholangitis confirmed by magnetic resonance cholangiography and the appearance of several pulmonary nodules. In lung and liver biopsies, the presence of Treponema pallidum was detected by molecular and immunohistochemistry techniques, and a diagnosis of cholangitis and pulmonary syphilis was made.

Rectal bleeding caused by a syphilitic inflammatory mass

A 47-year-old man presented with fatigue, decrease appetite, abdominal pain and rectal bleeding. His colonoscopy revealed a single, firm, raised, centrally ulcerated mass at the anorectal junction. During this same admission, he was diagnosed with HIV and syphilis, found to have multiple hepatic lesions and positive cerebrospinal fluidvenereal disease research laboratory test (VDRL). Biopsies from both the hepatic lesions and rectal ulcer showed spirochaetes by immunostaining. The initial presentation was felt to be secondary to a rectal inflammatory mass caused by syphilis.

A Systematic Literature Review of Syphilitic Hepatitis in Adults

Syphilitic hepatitis in adults is not frequently found in the population and is easily misdiagnosed. The incidence of viral hepatitis is increasing year by year, concomitantly increasing the importance of obtaining a systematic understanding of the clinical features and treatment strategies for this disease. There is, however, a lack of published definitive data regarding the clinical characteristics, diagnosis and standard treatment options for this disease. Searches were made using the MEDLINE database of PubMed and OVID for syphilitic hepatitis publications from 1951 to 2017 in an attempt to analyze and summarize the clinical characteristics.

The Great Impostor: Transaminitis Masking the Coinfection of Syphilis and Human Immunodeficiency Virus

Introduction. The incidence of syphilis continues to rise in the United States over the past 15 years. This disease process is classified into stages and may present with a coinfection of Human Immunodeficiency Virus (HIV). Case Report. We present a case of a 32-year-old African American male who presented with cutaneous manifestations of secondary syphilis and transaminitis. A workup revealed that the transaminitis was secondary to underlying syphilitic hepatitis in the presence of HIV coinfection. The patient had a reactive rapid plasma reagin (RPR) of 1 : 64 TU and reactive Treponema pallidum particle agglutination assay (TPPA). Lab findings showed alkaline phosphate (ALP) of 648 unit/L, aspartate aminotransferase (AST) of 251 unit/L, and alanine aminotransferase (ALT) of 409 unit/L. Conclusion. Syphilitic hepatitis is a recognized entity in the medical literature. It is a manifestation of secondary syphilis and it is more commonly seen in coinfected patients with both syphilis and HIV. Therefore, primary care physicians should keep infectious etiologies (e.g., syphilis and HIV) in the differential diagnosis of patients who present with unexplained liver dysfunction in a cholestatic pattern.

Syphilitic hepatitis treated with doxycycline in an HIV-infected patient and review of the literature

An HIV-infected male patient who had sex with men and with a penicillin allergy presented with liver dysfunction due to secondary syphilis and was successfully treated with doxycycline. This case highlights that syphilitic hepatitis may be overlooked in this particular population, and health care providers should be attuned to this diagnosis. Doxycycline may be an acceptable alternative to penicillin for treatment of this clinical syndrome.

Syphilis presenting as inflammatory tumors of the liver in HIV-positive homosexual men

Syphilis, a sexually transmitted infection caused by the spirochete Treponema pallidum, has seen a resurgence since 2001, particularly in men who have sex with men. Syphilis can affect the liver during the secondary stage as syphilitic hepatitis and during the tertiary stage as gummas. We describe 3 cases of syphilis in human immunodeficiency virus-positive homosexual men that presented as hepatic mass lesions clinically suspected of being malignant tumors. Histologically, 2 of the 3 cases showed a plump spindle cell proliferation, mixed inflammatory infiltrate with numerous neutrophils, and abscesses, whereas the third case showed granulomas and pericholangitis/cholangitis. Immunohistochemical staining for T. pallidum showed innumerable organisms in 2 of the cases. Pathologists must be aware of the possibility of syphilis causing hepatic inflammatory masses in human immunodeficiency virus-positive men who have sex with men in order to avoid misdiagnosis or delayed treatment.

Rapid progression to gummatous syphilitic hepatitis and neurosyphilis in a patient with newly-diagnosed HIV

We review the literature on hepatic involvement in patients with HIV and syphilis co-infection and describe a case of rapid progression to neurosyphilis and presumed gummatous syphilitic hepatitis in a patient newly diagnosed with HIV. To our knowledge, this is the first case of syphilitic hepatitis with gummas described in the HIV population.

Syphilis as a diagnosis of liver abnormalities in HIV

In order to investigate syphilitic liver involvement in HIV-infected patients, a single-centre retrospective study of a cohort of HIV-infected patients with syphilis was performed at the Infectious Diseases Clinic of Perugia, Italy, between December 2002 and March 2010. Fifty HIV-infected patients were identified with syphilis plus baseline and follow-up liver tests. The following syphilis diagnoses were recorded: 19 secondary (38%), 26 latent (52%), and 5 tertiary/neurosyphilis (12%). Syphilitic hepatitis was found in 5/50 (10%) patients. This finding supports the importance of including syphilis in the differential diagnosis of liver enzyme abnormalities in HIV-infected patients. An early diagnosis of syphilitic hepatitis can lead to rapid normalization of liver function following appropriate therapy, prevents the progression of syphilis, and limits the further spread of sexually transmitted diseases, including HIV.