Special Coverage of 41st IDSA Conference

Study: Syphilitic hepatitis connected to liver disease

Diagnosis is uncommon, but does occur

Investigators in Washington, DC, have discovered cases of HIV patients who have significant liver dysfunction that is caused by secondary syphilis instead of the usual suspects of hepatitis C, medication side effects, and substance abuse.

"We had a few patients we were diagnosing initially, and we decided to look for more cases and see if there were any more within our program and practice, and we found a few more cases," says Charu J. Mullick, MD, a resident and fellow at George Washington University in the department of infectious disease in Washington, DC.

"A lot of times you have patients with liver function abnormalities that you can attribute to alcohol abuse or medication side effects," she says. "But one thing to keep in mind is that syphilis also can affect the liver."

Since 2001, investigators identified five HIV-infected patients with syphilitic hepatitis, and all five had a rash. Jaundice, fever, and abdominal pain were each experienced by two patients.1

The patients who had jaundice were admitted to the hospital to find out what was causing the condition, Mullick notes. Clinicians screened each of the five patients for syphilis as part of a general lab work-up, and that’s how the infection was discovered, she says. "Most of these patients previously had negative syphilis serologies."

Previous syphilis tests were conducted from six months to 1.5 years earlier, Mullick adds.

The case series suggests that clinicians should consider syphilitic hepatitis as a potential cause for liver dysfunction when they are treating HIV-infected patients, she says.

"If there are liver abnormalities, they should keep syphilis in mind," Mullick adds.

With syphilitic hepatitis, the treatment is antibiotics, and the liver will return to normal, so it’s easy to diagnose and easy to treat, if clinicians think to check for this infection as well as other potential causes of hepatitis, she explains.

There are little data on how HIV patients are affected by secondary syphilis, which is why Mullick and co-investigators decided to study this co-infected population. "We’re trying to understand why syphilitic hepatitis is undiagnosed and unreported, and as we gather more patients we may have an answer," she says.

Reference

1. Mullick CJ, Liappis AP, Benator DA, et al. The presentation of syphilitic hepatitis among HIV-infected patients: A case series. Presented at the 41st annual meeting of the Infectious Diseases Society of America. San Diego; Oct. 9-12, 2003. Abstract 625.