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Abstract
Syphilis, The “Great Imitator” In The Setting Of HIV Disease. Isolated, Concurrent Acute Hepatitis And Meningitis
Manfredi R.1, Sabbatani S.1, Attard L.1, Chiodo F.1
Introduction: Isolated,major hepatic-CNS involvement by syphilis is very infrequent.
Methods: An exceedingly rare episode of concurrent syphilitic hepatitis (documented by histopathology),and meningitis occurred in a homosexual patient with treated HIV infection and persistent headache,fatigue,mild pyrexia,itching and jaundice,is reported.
Results: The abnormal liver profile included 11-13-fold increased transaminases,and evident cholestasis. Relying on serology,hepatitis A,B,and C,acute HSV,VZV,CMV,EBV,Toxoplasma gondii,Enteroviruses,Influenza,Adenovirus,and Parvovirus were excluded,while all cultures proved negative,as well as search of serum cryptococcal and CMV antigens,and testing for autoimmune,metabolic,or toxic hepatitis.The histopathological study performed after liver biopsy showed portal-intralobular inflammatory infiltrates,sparse Councilman bodies,activated Kupffer cells,and a localized portal fibrosis,with predominant cholestasis (Knodell score 5).The persisting headache prompted a brain CT scan which showed signs of mild diffuse parenchimal edema.A lumbar puncture disclosed an increased CSF WBC count (70/µL),elevated albumin (1.1 g/L),increased intratechal synthesis of immunoglobulins,and negative cultures.Syphilis serology performed on both CSF and serum finally disclosed elevated VDRL and TPHA assays,with an IgM-positive Treponema pallidum FTA-ABS testing.Our patient was not aware of contacts with subjects with known syphilis,and other signs and symptoms of primary-secondary syphilis, so that concurrent hepatitis and meningitis were the only signs of disease. Intravenous daily 24 MU penicillin was administered for 14 days,leading to a complete resolution of headache,and a drop of hepatic enzymes.
Conclusions: Our report looks unique from an epidemiologic,diagnostic,clinical,and therapeutic point of view.The occurrence of isolated,concurrent,and predominant acute involvement of liver and CNS as the sole clues of an underlying missed syphilis seems an exceedingly rare finding, since no similar episodes were described to date. Excluding coincidental liver and/or CNS disorders is a major concern,especially in HIV-infected patients who are at increased risk of viral hepatitis,opportunism,and drug toxicity.Although representing a rare occurrence,this report underlines that the attention against STD is progressively declining. Improved information and targeted educational programs are warranted as public health priorities, to avoid missed or delayed syphilis recognition.
The 3rd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
TuPe7.5C03
Suggested Citation
"ManfrediR., et al.
Syphilis, The “Great Imitator” In The Setting Of HIV Disease. Isolated, Concurrent Acute Hepatitis And Meningitis.
Poster Exhibition:
The 3rd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
TuPe7.5C03"
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