A case of early syphilitic hepatitis was difficult to diagnose until a skin eruption developed

Abstract

A man in his twenties was admitted to our hospital because of general fatigue and epigastric discomfort. Liver function test results were markedly abnormal. Hepatitis virus markers and antinuclear antibody were negative, and because he had been taking herbal medicines and a skin eruption developed on admission, we suspected drug-induced liver injury. Histological liver findings were not specific except for submassive necrosis in Zone 3. The transaminase levels improved gradually, but the abnormal values were prolonged without normalization, and the skin eruption spread. After obtaining a detailed history, which revealed multiple past sex partners, a serological test for syphilis was positive. Oral administration of amoxicillin was started. The hepatobiliary enzymes improved to normal levels immediately, and the eruption disappeared. Because of the recent increasing incidence of syphilitic infections in Japan, especially among younger persons, syphilitic infections should be considered when diagnosing acute hepatitis.