ACUTE HEPATITIS AS THE ONLY SYMPTOM OF SE CONDARY SYPHILIS

History and clinical findings: A 44-year-old heterosexual man reported having been jaundiced for 4 days. He drank little alcohol. There was no history of venereal disease. Investigations: Laboratory tests indic ated marked cholestasis (alkaline phosphatase 1589 U/l, gamma-GT 449 U /l), but only moderately raised transaminases (GOT 66 U/l, GPT 230 U/l ), with a bilirubin level of 4.8 mg/dl. Ultrasonography revealed diffu se parenchymal damage in the liver, while endoscopic retrograde cholan giopancreatography showed no abnormalities. Viral hepatitis was exclud ed by serological tests. Histology of a liver biopsy showed inflammato ry infiltration of the portal areas and of the liver parenchyma. Routi ne syphilis serology indicated fresh infection with Treponema pallidum . There was a healing painless ulcer in the area of the sulcus coronar ius of the genitals. Treatment and course: 2.4 mill. I.U. benzathinebe nzylpenicillin were administered intramuscularly. This rapidly improve d his condition and liver function tests became normal. Conclusion: In case of hepatitis of uncertain genesis syphilis should be considered as a possible cause, even in the absence of other signs of the disease .