Journal Article

Syphilitic Hepatitis in HIV-Infected Patients: A Report of 7 Cases and Review of the Literature

C. J. Mullick, A. P. Liappis, D. A. Benator, A. D. Roberts, D. M. Parenti and G. L. Simon

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 10, pages e100-e105
Published in print November 2004 | ISSN: 1058-4838
Published online November 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/425501
Syphilitic Hepatitis in HIV-Infected Patients: A Report of 7 Cases and Review of the Literature

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Background. A recent resurgence of primary and secondary syphilis has been observed in certain population groups, particularly among persons infected with human immunodeficiency virus (HIV). Liver involvement is an infrequently recognized complication of early syphilis, with no previous reports among HIV-infected patients.

Methods. We describe 7 cases of syphilitic hepatitis in HIV-positive individuals and review the literature.

Results. At our institutions, all patients presented with a rash consistent with secondary syphilis. Each case was characterized by a conspicuous increase in serum alkaline phosphatase level (mean level ± standard deviation, 905 ± 523.6 IU/L) and milder elevations in serum transaminase levels. The mean CD4+ absolute T cell count was 317 cells/mm3, and the median rapid plasma reagin (RPR) titer was 1:128. There was a significant correlation between higher CD4+ cell counts and the RPR titers (R = 0.93; P = .002). Symptomatic resolution and biochemical improvement, particularly a significant decrease in serum alkaline phosphatase levels (P = .02), occurred following antibiotic therapy.

Conclusions. Hepatic dysfunction is not uncommon in HIV-infected persons and is attributable to multiple causes. In the appropriate clinical setting, syphilitic hepatitis is an easily diagnosed and reversible etiology of liver dysfunction. The recognition of this entity will prevent unnecessary evaluation of abnormal liver enzyme levels in HIV-positive patients.

Journal Article.  3439 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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