Vera Hapshy, DO1, Idan Grossman, MD2, Karolina Kaczmarczyk, MD, MPH3, Harshavardhan Sanekommu, MD4, Mohammad Hossain, MD4, Lee Peng, MD, PhD4 1Hackensack Meridian JSUMC, Neptune City, NJ; 2Jersey Shore University Medical Center, Neptune, NJ; 3Hackensack Meridian Jersey Shore University Medical Center, Neptune City, NJ; 4Hackensack Meridian Health, Neptune, NJ Introduction: Syphilitic hepatitis is a rare manifestation of secondary syphilis that may present with nonspecific symptoms and abnormal liver function tests. Due to its variable presentation and low index of suspicion, it is often underdiagnosed. We present the case of a 26-year-old male with neurodevelopmental and psychiatric comorbidities who developed jaundice and cholestatic liver enzyme abnormalities. This case highlights the importance of including syphilitic hepatitis in the differential diagnosis of unexplained jaundice.
Case Description/
Methods: A 26-year-old man with a history of bipolar disorder, autism spectrum disorder, and ADHD presented with scleral icterus and periumbilical abdominal pain for two days. He denied substance use, recent travel, or infectious contacts. On admission, labs showed total bilirubin of 11.5 mg/dL, ALP 961 U/L, AST 275 U/L, and ALT 298 U/L. Hepatitis panel was negative. CT abdomen/pelvis revealed no biliary obstruction. RUQ ultrasound showed no biliary ductal dilation, with a 3.2 mm common bile duct. MRCP demonstrated enlarged porta hepatis and aortocaval lymph nodes with restricted diffusion. CMV and EBV serologies were positive (IgG and IgM). Tumor markers CA 19-9 and CEA-125 were markedly elevated. Liver and lymph node biopsies showed acute inflammation with neutrophils and eosinophils, bile duct injury and proliferation, consistent with a biliary pattern of injury, without evidence of malignancy. Serum RPR returned reactive with positive treponemal confirmation. The diagnosis of syphilitic hepatitis was confirmed on reanalysis of liver tissue using spirochete immunostain, which showed rare Treponema pallidum organisms. The patient was treated with intramuscular Penicillin G 2.4 million units weekly for three weeks, resulting in marked improvement in bilirubin and liver enzymes. Discussion: elevations when routine etiologies are excluded. Diagnosis can be challenging due to its nonspecific clinical features and resemblance to other hepatic or systemic diseases. In this case, liver biopsy with confirmatory immunostaining was crucial in establishing the diagnosis. Clinical and biochemical response to penicillin therapy supports the importance of early recognition and treatment. Providers should maintain a high index of suspicion for syphilitic hepatitis, even in patients without classic risk factors or symptoms.
Disclosures: Vera Hapshy indicated no relevant financial relationships. Idan Grossman indicated no relevant financial relationships. Karolina Kaczmarczyk indicated no relevant financial relationships. Harshavardhan Sanekommu indicated no relevant financial relationships. Mohammad Hossain indicated no relevant financial relationships. Lee Peng indicated no relevant financial relationships.
Vera Hapshy, DO1, Idan Grossman, MD2, Karolina Kaczmarczyk, MD, MPH3, Harshavardhan Sanekommu, MD4, Mohammad Hossain, MD4, Lee Peng, MD, PhD4. P1844 - Spiraling Toward the Truth: A Rare Case of Syphilitic Hepatitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
