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Monday Poster Session

Category: Liver

P3959 - A Case of Syphilitic Hepatitis in a 21-Year-Old Man

Monday, October 27, 2025
10:30 AM - 4:00 PM MT
Location: Exhibit Hall

    Presenting Author(s)

  • Ahmed Shukri, MD

    Texas Tech University Health Sciences Center
    Lubbock, TX

Atul Ratra, MD1, Ahmed Shukri, MD1, Kanak Das, MD2
1Texas Tech University Health Sciences Center, Lubbock, TX; 2Texas Tech University, Lubbock, TX

Introduction: Syphilitic hepatitis is an uncommon form of liver injury that can progress to fulminant liver failure and cirrhosis if not timely recognized. We present a rare case of syphilitic hepatitis in a young male who presented with rectal bleeding.

Case Description/

Methods: A 21-year-old male was admitted with complaint of bleeding per rectum. History revealed high risk sexual behavior. Physical exam was negative for skin rashes. Colonoscopy showed multiple rectal ulcers and an anal fissure. Incidentally, blood work revealed markedly elevated Alkaline Phosphatase of 1230 IU/L [normal: 52-128 IU/L], mildly elevated total bilirubin of 2.9 mg/dL [normal: 0-0.3 mg/dL], ALT 96 IU/L [normal: 5-40 IU/L] and AST 73 IU/L [normal: 9-48 IU/L] levels. HIV, HBV and HCV serology tests were negative. Abdominal Ultrasonography was negative for choledocholithiasis. Liver biopsy showed a liver parenchyma with mild to moderate mixed portal inflammation, focal ductular reaction and edema but with no significant cholestasis or fibrosis. Nontreponemal testing for syphilis returned positive with an RPR titer of 1:64 and a positive treponemal (Treponema Pallidum Particle Agglutination) test assay. Patient was treated with 2.4 million units of intramuscular benzathine penicillin weekly for 3 weeks. Patient had complete resolution of liver chemistry abnormalities following the treatment course.

Discussion: Syphilis is a sexually and vertically transmitted disease caused by the bacteria Treponema pallidum. Syphilis can cause severe complications involving multiple organ systems if not timely detected and treated. Diagnosis is often challenging as the symptoms differ during the three disease stages and can mimic multiple other ailments. Syphilitic hepatitis typically presents with a cholestatic pattern of liver test abnormalities, usually in the second stage of the infection spectrum. Timely diagnosis of syphilitic hepatitis is essential in definitive treatment and preventing progression to fatal fulminant liver failure, irreversible liver cirrhosis and other late stage complications.

Disclosures:
Atul Ratra indicated no relevant financial relationships.
Ahmed Shukri indicated no relevant financial relationships.
Kanak Das indicated no relevant financial relationships.

Atul Ratra, MD1, Ahmed Shukri, MD1, Kanak Das, MD2. P3959 - A Case of Syphilitic Hepatitis in a 21-Year-Old Man, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.