Syphilitic hepatitis in an HIV co-infected patient: A case report

Syphilitic hepatitis is a rare complication of secondary syphilis, which may be misdiagnosed or overlooked during management.
A 33-year-old male presented with a penile ulcer and rash over the penile shaft and scrotum for a 10-day duration. He had multiple sexual exposures with male partners. He was not icteric, but had macular rashes over his palms and soles with multiple macular scaly skin lesions over the penile shaft and scrotal skin. The non-tender syphilitic ulcer was suggestive of a healing chancre. Bilateral painless inguinal lymphadenopathy was noted. There was no hepatic tenderness. His VDRL test titre was R64, and the TPPA test was positive. The HIV confirmatory test was positive too. Liver enzymes and total bilirubin were elevated with negative Hepatitis B Surface Antigen and Hepatitis C Antibody.
Following treatment of syphilis, hepatitis resolved, indicating that, while evaluating a young male with elevated liver enzymes, early syphilis needs to be considered.