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Cholestatic hepatitis and thrombocytosis in a secondary syphilis patient.

Kim GH, Kim BU, Lee JH, Choi YH, Chae HB, Park SM, Youn SJ, Lee JY, Yoon TY, Sung R - J. Korean Med. Sci. (2010)

Bottom Line: The 42-yr-old male complained of flu-like symptoms and skin eruptions on his palms and soles.He recovered from his symptoms and elevated liver related enzymes with treatment.Because syphilitic hepatitis can present without any typical signs of accompanying syphilis, syphilis should be considered as a possible cause in acute hepatitis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chungbuk National University, College of Medicine and Medical Research Institute, Cheongju, Korea.

ABSTRACT
The incidence of acute hepatitis in syphilis patient is rare. First of all, our patient presented with hepatitis comorbid with thrombocytosis. To our knowledge, this is only the second report of syphilitic hepatitis with thrombocytosis. The 42-yr-old male complained of flu-like symptoms and skin eruptions on his palms and soles. Laboratory findings suggested an acute hepatitis and thrombocytosis. Serologic test results were positive for VDRL. He recovered from his symptoms and elevated liver related enzymes with treatment. Because syphilitic hepatitis can present without any typical signs of accompanying syphilis, syphilis should be considered as a possible cause in acute hepatitis patients.

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Computed tomographic findings. (A) Horizontal, (B) Coronal section. They show no dilatation of the intrahepatic and extrahepatic bile ducts, but the gall bladder wall was thickened.
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Figure 2: Computed tomographic findings. (A) Horizontal, (B) Coronal section. They show no dilatation of the intrahepatic and extrahepatic bile ducts, but the gall bladder wall was thickened.

Mentions: On 21 May 2009, a 42-yr-old male patient visited our hospital because of malaise and jaundice. He had been working as an office manager of a trading company in China for two years. Two mild fever, and one month before examination, he felt unusual fatigue and jaundice. Twenty days before examination, he had been informed that his acute hepatitis was unusual because he had no hepatitis A, B, or C viral markers. He took herbal medication and received acupuncture in China under the diagnosis of acute hepatitis of unknown origin. His symptoms improved under herbal medication, but remained. He returned to Korea for treatment of the acute hepatitis. He had no other symptoms except for scanty whitish phlegm. He had been healthy until the recent illness. He was not currently on medication, was not an injecting drug abuser. He did not smoke nor drink alcohol. He had received no blood transfusion. He had been married for seven years, but had lived alone in China for two years. He was well oriented and his vital signs were normal. Physical examination revealed icteric sclera and tender hepatomegaly. No mucous membrane lesions nor lymphadenopathy were present and he was afebrile. Cutaneous manifestations consisted of macular and papular lesions, about 0.5 cm in diameter, localized on the trunk, palms, and soles (Fig. 1). Genital examination revealed no lesions nor ulcers. Lymph nodes were not palpable in the neck, axillary, or inguinal areas. Laboratory tests showed the following: alkaline phosphatase (ALP) 2,974 IU/L, gamma glutamyl transpeptidase (GGT) 1,755 IU/L, aspartate transaminase (AST) 89 IU/L, alanine transaminase (ALT) 119 IU/L, total bilirubin 8.3 mg/dL, direct bilirubin 6.9 mg/dL, creatinine 0.8 mg/dL, albumin 2.4 g/dL, total protein 9.2 g/dL, white blood cell (WBC) 13,600/µL, hemoglobin 9.7 g/dL, platelets 752,000/µL, international normalized ratio (INR) 1.06, venereal disease research laboratory (VDRL) was positive with a titer >1:1,024, and his fluorescent treponemal antibody absorption (FTA-ABS) was reactive. A hepatitis panel including IgM anti-HAV, HBsAg, and anti-HCV, antinuclear antibody, ceruloplasmin, copper, alpha-1 antitrypsin deficiency, and human immunodeficiency virus (HIV) were all nonreactive. Computerized tomography didn't show any evidence of bile duct obstruction. It showed also mildly enlarged liver, nonspecifically enlarged lymph nodes at the porta hepatis area, and thickened gall bladder wall (Fig. 2). Chest radiography was normal.


Cholestatic hepatitis and thrombocytosis in a secondary syphilis patient.

Kim GH, Kim BU, Lee JH, Choi YH, Chae HB, Park SM, Youn SJ, Lee JY, Yoon TY, Sung R - J. Korean Med. Sci. (2010)

Computed tomographic findings. (A) Horizontal, (B) Coronal section. They show no dilatation of the intrahepatic and extrahepatic bile ducts, but the gall bladder wall was thickened.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2967006&req=5

Figure 2: Computed tomographic findings. (A) Horizontal, (B) Coronal section. They show no dilatation of the intrahepatic and extrahepatic bile ducts, but the gall bladder wall was thickened.
Mentions: On 21 May 2009, a 42-yr-old male patient visited our hospital because of malaise and jaundice. He had been working as an office manager of a trading company in China for two years. Two mild fever, and one month before examination, he felt unusual fatigue and jaundice. Twenty days before examination, he had been informed that his acute hepatitis was unusual because he had no hepatitis A, B, or C viral markers. He took herbal medication and received acupuncture in China under the diagnosis of acute hepatitis of unknown origin. His symptoms improved under herbal medication, but remained. He returned to Korea for treatment of the acute hepatitis. He had no other symptoms except for scanty whitish phlegm. He had been healthy until the recent illness. He was not currently on medication, was not an injecting drug abuser. He did not smoke nor drink alcohol. He had received no blood transfusion. He had been married for seven years, but had lived alone in China for two years. He was well oriented and his vital signs were normal. Physical examination revealed icteric sclera and tender hepatomegaly. No mucous membrane lesions nor lymphadenopathy were present and he was afebrile. Cutaneous manifestations consisted of macular and papular lesions, about 0.5 cm in diameter, localized on the trunk, palms, and soles (Fig. 1). Genital examination revealed no lesions nor ulcers. Lymph nodes were not palpable in the neck, axillary, or inguinal areas. Laboratory tests showed the following: alkaline phosphatase (ALP) 2,974 IU/L, gamma glutamyl transpeptidase (GGT) 1,755 IU/L, aspartate transaminase (AST) 89 IU/L, alanine transaminase (ALT) 119 IU/L, total bilirubin 8.3 mg/dL, direct bilirubin 6.9 mg/dL, creatinine 0.8 mg/dL, albumin 2.4 g/dL, total protein 9.2 g/dL, white blood cell (WBC) 13,600/µL, hemoglobin 9.7 g/dL, platelets 752,000/µL, international normalized ratio (INR) 1.06, venereal disease research laboratory (VDRL) was positive with a titer >1:1,024, and his fluorescent treponemal antibody absorption (FTA-ABS) was reactive. A hepatitis panel including IgM anti-HAV, HBsAg, and anti-HCV, antinuclear antibody, ceruloplasmin, copper, alpha-1 antitrypsin deficiency, and human immunodeficiency virus (HIV) were all nonreactive. Computerized tomography didn't show any evidence of bile duct obstruction. It showed also mildly enlarged liver, nonspecifically enlarged lymph nodes at the porta hepatis area, and thickened gall bladder wall (Fig. 2). Chest radiography was normal.

Bottom Line: The 42-yr-old male complained of flu-like symptoms and skin eruptions on his palms and soles.He recovered from his symptoms and elevated liver related enzymes with treatment.Because syphilitic hepatitis can present without any typical signs of accompanying syphilis, syphilis should be considered as a possible cause in acute hepatitis patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Chungbuk National University, College of Medicine and Medical Research Institute, Cheongju, Korea.

ABSTRACT
The incidence of acute hepatitis in syphilis patient is rare. First of all, our patient presented with hepatitis comorbid with thrombocytosis. To our knowledge, this is only the second report of syphilitic hepatitis with thrombocytosis. The 42-yr-old male complained of flu-like symptoms and skin eruptions on his palms and soles. Laboratory findings suggested an acute hepatitis and thrombocytosis. Serologic test results were positive for VDRL. He recovered from his symptoms and elevated liver related enzymes with treatment. Because syphilitic hepatitis can present without any typical signs of accompanying syphilis, syphilis should be considered as a possible cause in acute hepatitis patients.

Show MeSH
Related in: MedlinePlus