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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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Related in: MedlinePlus

Findings of tissue biopsy findings. (A) Liver. Stromal edema is observed around the portal tract. Both focal necrosis and infiltration of lymphocytes, eosinophils and neutrophils in the lobule are also observed (periodic acid-Schiff stain, ×200). (B) Skin. The epidermis shows parakeratosis, acanthosis with elongation of rete ridges, and exocytosis of lymphocytes. A dense perivascular inflammatory infiltrate is seen in A the dermis (H&E, ×100).
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Figure 3: Findings of tissue biopsy findings. (A) Liver. Stromal edema is observed around the portal tract. Both focal necrosis and infiltration of lymphocytes, eosinophils and neutrophils in the lobule are also observed (periodic acid-Schiff stain, ×200). (B) Skin. The epidermis shows parakeratosis, acanthosis with elongation of rete ridges, and exocytosis of lymphocytes. A dense perivascular inflammatory infiltrate is seen in A the dermis (H&E, ×100).

Mentions: Liver biopsy revealed portal-to-portal or portal to central zone bridge necrosis, and widening by lymphocyte infiltration, accompanied by intracanalicular and intracellular cholestasis. These findings were compatible with acute hepatitis (Fig. 3A). A modified Warthin-Starry stain was negative for spirochetes. Skin biopsy revealed a perivascular mixed-cell infiltrate of prominent plasma cells, lymphocytes, and histiocytes around a blood vessel that contained swollen endothelial cells (Fig. 3B).


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)

Findings of tissue biopsy findings. (A) Liver. Stromal edema is observed around the portal tract. Both focal necrosis and infiltration of lymphocytes, eosinophils and neutrophils in the lobule are also observed (periodic acid-Schiff stain, ×200). (B) Skin. The epidermis shows parakeratosis, acanthosis with elongation of rete ridges, and exocytosis of lymphocytes. A dense perivascular inflammatory infiltrate is seen in A the dermis (H&E, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Findings of tissue biopsy findings. (A) Liver. Stromal edema is observed around the portal tract. Both focal necrosis and infiltration of lymphocytes, eosinophils and neutrophils in the lobule are also observed (periodic acid-Schiff stain, ×200). (B) Skin. The epidermis shows parakeratosis, acanthosis with elongation of rete ridges, and exocytosis of lymphocytes. A dense perivascular inflammatory infiltrate is seen in A the dermis (H&E, ×100).
Mentions: Liver biopsy revealed portal-to-portal or portal to central zone bridge necrosis, and widening by lymphocyte infiltration, accompanied by intracanalicular and intracellular cholestasis. These findings were compatible with acute hepatitis (Fig. 3A). A modified Warthin-Starry stain was negative for spirochetes. Skin biopsy revealed a perivascular mixed-cell infiltrate of prominent plasma cells, lymphocytes, and histiocytes around a blood vessel that contained swollen endothelial cells (Fig. 3B).

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