scholarly journals Exploring the Ways of “The Great Imitator”: A Case Report of Syphilitic Hepatitis

2021 ◽  
pp. 1-4
Author(s):  
João A. Cunha Neves ◽  
Joana Roseira ◽  
Helena Tavares de Sousa ◽  
Rui Machado
Keyword(s):  
Immune Responses ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Liver Function Tests ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Sexually Transmitted ◽  
Patients At Risk ◽  
Mixed Pattern

<b><i>Introduction:</i></b> Syphilis is a chronic infection caused by <i>Treponema pallidum</i>. Manifestations of this disease are vast, and syphilitic hepatitis is a rarely depicted form of secondary syphilis. <b><i>Case Presentation:</i></b> We report the case of a 63-year-old man with worsening jaundice, maculopapular rash and perianal discomfort. Proctological examination with anoscopy revealed a perianal gray/white area with millimetric pale granules along the anal canal. Liver function tests showed a mixed pattern. Venereal Disease Research Laboratory, <i>T. pallidum</i> hemagglutination assay and IgM fluorescent treponemal antibody absorbance were positive. The patient was successfully treated with a single dose of penicillin G. <b><i>Discussion/Conclusion:</i></b> Syphilitic hepatitis is scarcely reported in the literature. Secondary syphilis with mild hepatitis rarely leads to hepatic cytolysis and jaundice. Many signs of secondary syphilis including syphilitic hepatitis may be linked to immune responses initiated during early infection. Over the past decades, evidence has emerged on the importance of innate and adaptive cellular immune responses in the immunopathogenesis of syphilis. This report raises awareness to a clinical entity that should be considered in patients at risk for sexually transmitted diseases, who present with intestinal discomfort or liver dysfunction, as it is a treatable and fully reversible condition.

scholarly journals Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

2021 ◽  
Vol 7 (6) ◽  
pp. 872
Author(s):  
Rajesh Munusamy ◽  
Nithin Nagaraja
Keyword(s):  
Sexual Abuse ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Intellectually Disabled ◽  
Transmitted Infection ◽  
Sexual Transmitted Infection ◽  
Benzathine Penicillin G

<p class="abstract">Syphilis is a sexual transmitted infection (STI) caused by a spirochete, <em>Treponema pallidum</em>. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and <em>Treponema pallidum </em>hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.</p><p class="abstract"> </p>

scholarly journals Hepatitis in patients with syphilis: an overlooked association

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-226918 ◽  
Author(s):  
Ana Carina Pizzarossa ◽  
Martín Rebella
Keyword(s):  
Risk Factors ◽  
Research Laboratory ◽  
Liver Enzymes ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Secondary Syphilis ◽  
Venereal Disease Research Laboratory ◽  
Disease Research ◽  
Trunk Limbs

We present the case of a patient who sought treatment for fever and a maculopapular rash involving the trunk, limbs, palms and soles. The patient also presented with hepatomegaly and elevated levels of liver enzymes (with a higher increase of alkaline phosphatase). With the proposal of early syphilitic hepatitis, during the stage of secondary syphilis, a venereal disease research laboratory andTreponema pallidumhaemagglutination tests were requested, which confirmed the diagnosis. All altered parameters improved with antibiotic treatment for secondary syphilis. Syphilitic hepatitis is an often overlooked presentation of syphilis and should be considered as a differential diagnosis in patients with elevated levels of liver enzymes and risk factors for syphilis.

scholarly journals Importance of Serological Tests in the Diagnosis of Asymptomatic Congenital Syphilis in Neonates: A Case Report

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Brigitta Ida Resita Vebrianti Corebima ◽  
Ayunda Almiradani ◽  
Eko Sulistijono
Keyword(s):  
Congenital Syphilis ◽  
Nasal Congestion ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Vital Role ◽  
Penicillin G ◽  
Serological Tests ◽  
Procaine Penicillin ◽  
Test Result

Introduction: Congenital Syphilis (CS) is caused by the vertical transmission of Treponema pallidum during pregnancy. Here, we describe a case of CS, diagnosed solely by serological tests. Case Presentation: The patient was a newborn with CS, whose mother was infected with Treponema pallidum at the gestational age of 16 - 20 weeks. However, the patient had no signs of early CS, such as low birth weight, nasal congestion, maculopapular rash, or hepatosplenomegaly. The histopathological features in both mother and neonate suggested syphilitic placentitis. Regarding the serological tests, a non-reactive Venereal Disease Research Laboratory (VDRL) test result and a reactive Treponema pallidum haemagglutination (TPHA) test result were reported. After establishing the diagnosis of CS, we initiated treatment with procaine penicillin G (50,000 U/kg body weight), which was injected intramuscularly once a day for 10 days. Six months after discharge, physical examinations showed normal findings and non-reactive results of VDRL and TPHA tests. Conclusions: It can be concluded that detailed history-taking and serological tests play a vital role in establishing the diagnosis of CS, particularly in patients with asymptomatic congenital syphilis. An early diagnosis of CS can guide clinicians to initiate a standardized treatment and improve patient outcomes.

scholarly journals Aseptic Syphilitic Meningitis in an HIV-Negative Patient with Concomitant Primary and Secondary Syphilis

2020 ◽  
Vol 4 (4) ◽  
pp. 361-364
Author(s):  
Antonio Roberto Jimenez ◽  
Paige Hoyer ◽  
Michael Wilkerson
Keyword(s):  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Drug Induced ◽  
Adequate Treatment ◽  
Cutaneous Manifestations ◽  
Dermatology Clinic ◽  
Morbilliform Rash

Background: Syphilis is a sexually and vertically transmitted disease caused by the Treponema pallidum species. Aseptic syphilitic meningitis (ASM) is a subcategory of neurosyphilis. Neurosyphilis is typically considered a tertiary manifestation of syphilis; however, ASM typically occurs within 6 months of exposure and may be concurrent with the rash of secondary syphilis. Case Presentation: A 58-year-old immunocompetent male presented to the dermatology clinic with an erythematous morbilliform rash that involved his trunk and upper extremities. He was prescribed benzonatate 100 mg 3 weeks prior for cough and was diagnosed with a drug-induced morbilliform rash. The patient was seen 1 month later by urology for a penile ulcer. At his urology appointment, an RPR test was done and resulted positive with a titer of 1:256. He was referred to dermatology again and was noted to have a diffuse, copper-colored maculopapular rash involving the palms and soles. During this appointment, the patient complained of a 4-week headache and was found to have nuchal rigidity. He was admitted for neurosyphilis work up, including CSF and CSF-VDRL examination. His neurologic symptoms improved on IV Penicillin G. Repeat RPR testing at 6 months follow up confirmed adequate treatment and his RPR declined from 1:256 to 1:4.  Conclusion: We present a case of ASM in an immunocompetent individual with concomitant primary and secondary syphilis. Dermatologists are trained to recognize the cutaneous manifestations of syphilis, but also should be familiar with the variable presentations of the disease, including the early neurological findings of ASM.  

scholarly journals Case Report: Syphilitic Hepatitis–A Rare and Underrecognized Etiology of Liver Disease With Potential for Misdiagnosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hiba A. Al Dallal ◽  
Siddharth Narayanan ◽  
Hanah F. Alley ◽  
Michael J. Eiswerth ◽  
Forest W. Arnold ◽  
...  
Keyword(s):  
At Risk ◽  
Case Report ◽  
Rare Condition ◽  
Liver Function Tests ◽  
Sexually Transmitted ◽  
Drug Use Disorders ◽  
Rare Manifestation ◽  
Patients At Risk ◽  
Risk Patients ◽  
Treponemal Infection

Syphilitic hepatitis (SH) in adults is a rare condition that can be easily misdiagnosed. Clinical and histopathologic manifestations of SH can mimic other infectious and non-infectious conditions, and the diagnosis should be considered in all at-risk patients with abnormal liver function tests. We present an unusual case of SH presenting with seizures and multiple liver lesions. This case report, in line with other newly published reports, promotes awareness of SH as a rare manifestation of treponemal infection and highlights the importance of including SH in the differential diagnosis for patients at risk for sexually transmitted infections and presenting with liver enzyme abnormalities. From a hospital quality control and socioeconomic perspective, our case adds to the growing body of evidence that demonstrates an increasing incidence of patients suffering from venereal diseases and injection drug use disorders, and the burden these conditions place on the healthcare system. Recognition of the clinicopathologic features of SH is required to prevent missed diagnosis and to foster systematic crosstalk between healthcare staff and public health personnel managing this problem.

Atypical development of neurosyphilis mimicking limbic encephalitis

2018 ◽  
Vol 30 (2) ◽  
pp. 194-197 ◽  
Author(s):  
Karine Beiruti ◽  
Anan Abu Awad ◽  
Galina Keigler ◽  
Chen Hanna Ryder ◽  
Radi Shahien
Keyword(s):  
Limbic Encephalitis ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Penicillin G ◽  
Acute Confusional State ◽  
Gradual Improvement ◽  
Atypical Clinical Presentation ◽  
Magnetic Resonance Imaging Mri ◽  
Atypical Development ◽  
Simplex Virus

A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three months was referred to our facility. On admission, the patient was dysphasic and had tonic-clonic seizures. Neurological examination showed mental confusion, euphoric mood, mania, paranoia, and mild motor dysphasia. Magnetic resonance imaging (MRI) was performed twice but no abnormalities were revealed. His acute confusional state, elevated cerebrospinal fluid (CSF) protein, epileptic seizure and electroencephalogram showing intermittent frontal slowness were all suggestive of encephalitis. The patient was treated with acyclovir without significant improvement in his condition. Testing for herpes simplex virus and human immunodeficiency virus was negative. Limbic encephalitis was suspected and the patient was treated with intravenous immunoglobulin (IVIG) for five days. Venereal disease research laboratory and Treponema pallidum hemagglutination assay were both tested positive in serum and CSF. Neurosyphilis was diagnosed, and the patient received a 14-day course of penicillin G with gradual improvement. Anti-N-methyl-D-aspartate-receptor (anti-NMDAR) antibodies were positive in serum, confirming the presence of encephalitis. The atypical clinical presentation of neurosyphilis with symptomatology mimicking encephalitis and no MRI abnormalities made the diagnosis challenging. Coexistence of neurosyphilis with anti-NMDAR encephalitis has been reported only in one recent study. Our case demonstrates the importance of testing for syphilis in patients with unexplained neurologic deficits and suspected encephalitis.

scholarly journals Performance of the 47-Kilodalton Membrane Protein versus DNA Polymerase I Genes for Detection of Treponema pallidum by PCR in Ulcers

2014 ◽  
Vol 53 (3) ◽  
pp. 976-980 ◽  
Author(s):  
Angèle Gayet-Ageron ◽  
Frédéric Laurent ◽  
Jacques Schrenzel ◽  
Béatrice Charton ◽  
Gisela Jimenez-Getaz ◽  
...  
Keyword(s):  
Target Gene ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Dna Polymerase I ◽  
Perfect Agreement ◽  
Content Type ◽  
Sexually Transmitted ◽  
Polymerase I ◽  
Pcr Targeting ◽  
Protein Versus

Treponema pallidumPCR (Tp-PCR) is a direct diagnostic method for primary and secondary syphilis, but there is no recommendation regarding the best choice of target gene. In this study, we sequentially tested 272 specimens from patients with sexually transmitted ulcers usingTp-PCR targeting thetpp47and thenpolAgenes. The two methods showed similar accuracies and an almost-perfect agreement.

scholarly journals Imunopatogenesis Treponema pallidum dan Pemeriksaan Serologi

2014 ◽  
Vol 3 (3) ◽  
Author(s):  
Efrida Efrida ◽  
Elvinawaty Elvinawaty
Keyword(s):  
Clinical Symptoms ◽  
Early Stage ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Major Health Problem ◽  
Sexually Transmitted ◽  
Tertiary Syphilis ◽  
History Of ◽  
Latent Syphilis

AbstrakSifilis adalah penyakit menular seksual yang sangat infeksius, disebabkan oleh bakteri berbentuk spiral, Treponema pallidum subspesies pallidum. Penyebaran sifilis di dunia telah menjadi masalah kesehatan yang besar dengan jumlah kasus 12 juta pertahun. Infeksi sifilis dibagi menjadi sifilis stadium dini dan lanjut. Sifilis stadium dini terbagi menjadi sifilis primer, sekunder, dan laten dini. Sifilis stadium lanjut termasuk sifilis tersier (gumatous, sifilis kardiovaskular dan neurosifilis) serta sifilis laten lanjut. Sifilis primer didiagnosis berdasarkan gejala klinis ditemukannya satu atau lebih chancre (ulser). Sifilis sekunder ditandai dengan ditemukannya lesi mukokutaneus yang terlokalisir atau difus dengan limfadenopati. Sifilis laten tanpa gejala klinis sifilis dengan pemeriksaan nontreponemal dan treponemal reaktif, riwayat terapi sifilis dengan titer uji nontreponemal yang meningkat dibandingkan dengan hasil titer nontreponemal sebelumnya. Sifilis tersier ditemukan guma dengan pemeriksaan treponemal reaktif, sekitar 30% dengan uji nontreponemal yang tidak reaktifKata kunci: sifilis, Treponema pallidum, serologiAbstractSyphilis is a sexually transmitted disease that is highly infectious, caused by a spiral -shaped bacterium, Treponema pallidum subspecies pallidum. The spread of syphilis in the world has become a major health problem and the common, the number of 12 million cases per year. Infectious syphilis is divided into early and late-stage syphilis. Early-stage syphilis is divided into primary, secondary, and early latent. Advanced stage of syphilis include tertiary syphilis (gumatous, cardiovascular syphilis, and neurosyphilis) and late latent syphilis. Primary syphilis is diagnosed by clinical symptoms of the discovery of one or more chancre (ulcer). Secondary syphilis is characterized by the finding of localized mucocutaneous lesions or with diffuse lymphadenopathy. Latent syphilis without clinical symptoms of syphilis with a nontreponemal and treponemal reactive examination, history of syphilis therapy in nontreponemal test titer increased compared with the results of previous nontreponemal titers. Tertiary syphilis is found guma with reactive treponemal examination, approximately 30% of the non- reactive nontreponemal testKeywords: syphilis, Treponema pallidum, serologi

scholarly journals Laboratory Examination of Syphilis

2021 ◽  
Vol 5 (3) ◽  
pp. 722-741
Author(s):  
M. Izazi Hari Purwoko ◽  
Mutia Devi ◽  
Suroso Adi Nugroho ◽  
Fitriani Fitriani ◽  
Raden Pamudji ◽  
...  
Keyword(s):  
Venereal Disease ◽  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Rapid Test ◽  
Dark Field ◽  
Morphological Observation ◽  
Serologic Test ◽  
Sexually Transmitted ◽  
Antibody Absorption

Syphilis, is sexually transmitted disease caused by spirochete Treponema pallidum subsp.pallidum. It have many diverse clinical manifestations that occur in distinct stages. Early diagnosis and management are the main things to prevent transmission and complication. Direct test or morphological observation is the definitive diagnosis of syphilis. This can be done through animal inoculation test, dark field microscopy, direct fluorescence antibody (DFA), and nucleid acid amplification test (NAAT). While the indirect test is a nontreponemal serologic test consist of Wasserman test, venereal disease research laboratory (VDRL), toluidine red unheated serum test (TRUST), unheated serum reagin (USR), rapid plasma reagin (RPR) and treponemal serologic test, such as T. pallidum passive particle agglutination (TPPA), T. pallidum haemagglutination assay (TPHA), fluorescent treponemal antibody absorption (FTA-Abs), enzyme immunoassay (EIA) and rapid test. The algorithm of serologic test can be divided into traditional or reverse.

scholarly journals Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report

2020 ◽  
Vol 32 (1) ◽  
pp. 75
Author(s):  
Ade Fernandes ◽  
Evy Ervianti
Keyword(s):  
Human Immunodeficiency Virus ◽  
Treatment Success ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Secondary Syphilis ◽  
Response To Treatment ◽  
Immunodeficiency Virus ◽  
Tertiary Stage ◽  
Sex With Men

Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM.  Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient’s response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.

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