Hepatic Secondary Syphilis Can Cause a Variety of Histologic Patterns and May Be Negative for Treponeme Immunohistochemistry.
Journal
The American journal of surgical pathology
ISSN: 1532-0979
Titre abrégé: Am J Surg Pathol
Pays: United States
ID NLM: 7707904
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
pubmed:
6
12
2021
medline:
22
4
2022
entrez:
5
12
2021
Statut:
ppublish
Résumé
The rate of syphilis in the United States has been increasing steadily in the past decade, but it remains an uncommon diagnosis in tissue biopsies. Most of the pathology literature on hepatic syphilis consists of older series or case reports. This study aimed to systematically characterize the histologic spectrum of hepatic syphilis in a contemporary cohort. Clinicopathologic features of 14 hepatic syphilis cases between 2012 and 2018 were analyzed to characterize the broad spectrum of histologic changes. Thirteen patients were men (age range: 19 to 59 y); 6 had known human immunodeficiency virus, 7 were men known to have sex with men, and no patient had known prior syphilis. Hepatic syphilis was the primary clinical suspicion in only 1 patient. Common symptoms included jaundice, rash, and abdominal pain. Thirteen had elevated transaminases, and 12 had elevated alkaline phosphatase. Pathologic changes were grouped into 5 histologic patterns: biliary-pattern injury (n=5), acute hepatitis (n=4), autoimmune hepatitis-like (n=1), fibroinflammatory mass-forming lesion (n=2), and no particular pattern (n=2). Nearly all showed portal and lobular lymphocytes and plasma cells; 12 had prominent histiocytes/Kupffer cells, 9 had ductular reaction, and 7 had duct inflammation. Occasional focal findings included dropout (n=7), phlebitis (n=7), and loose granulomata (n=5). Treponeme immunohistochemistry was positive in 10 and negative in 4, though treatment was given before biopsy in 3 of those 4. Thirteen patients had rapid plasma reagin testing either before or after biopsy, with 1:64 or higher titer. All patients who received treatment recovered. Hepatic syphilis is rare but likely underrecognized. It exhibits a variety of histologic appearances and therefore should be considered in several hepatic differential diagnoses, especially in men who have sex with men. Kupffer cells, granulomata, and phlebitis may suggest the diagnosis regardless of predominant histologic pattern. Negative treponeme immunohistochemical staining does not exclude the diagnosis, including in untreated patients.
Identifiants
pubmed: 34864775
doi: 10.1097/PAS.0000000000001848
pii: 00000478-202204000-00015
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
567-575Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Références
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance; 2018. Available at: www.cdc.gov/std/stats18/default.htm . Accessed July 19, 2021.
Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999;75:3–17.
Jarzebowski W, Caumes E, Dupin N, et al. Effect of early syphilis infection on plasma viral load and CD4 cell count in human immunodeficiency virus-infected men: results from the FHDH-ANRS CO4 cohort. Arch Intern Med. 2012;172:1237–1243.
Centers for Disease Control and Prevention. Syphilis elimination effort (SEE). Available at: www.cdc.gov/stopsyphilis/default.htm . Accessed July 19, 2021.
Fonner VA, Dalglish SL, Kennedy CE, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30:1973–1983.
Traeger MW, Cornelisse VJ, Asselin J, et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA. 2019;321:1380–1390.
Radolf JD, Tramont EC, Salazar JC Bennett JE, Dolin R, Blaser MJ. Syphilis ( Treponema pallidum ). Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 8th ed. Philadelphia, PA: Elsevier; 2014:2684–2709.
Shim HJ. Tertiary syphilis mimicking hepatic metastases of underlying primary peritoneal serous carcinoma. World J Hepatol. 2010;2:362–366.
Hagen CE, Kamionek M, McKinsey DS, et al. Syphilis presenting as inflammatory tumors of the liver in HIV-positive homosexual men. Am J Surg Pathol. 2014;38:1636–1643.
Huang J, Lin S, Wan B, et al. A systematic literature review of syphilitic hepatitis in adults. J Clin Transl Hepatol. 2018;6:306–309.
Sherlock S. The liver in secondary (early) syphilis. N Engl J Med. 1971;284:1437–1438.
Veeravahu M. Diagnosis of liver involvement in early syphilis. A critical review. Arch Intern Med. 1985;145:132–134.
Lee RV, Thornton GF, Conn HO. Liver disease associated with secondary syphilis. N Engl J Med. 1971;284:1423–1425.
Campisi D, Whitcomb C. Liver disease in early syphilis. Arch Intern Med. 1979;139:365–366.
Lo JO, Harrison RA, Hunter AJ. Syphilitic hepatitis resulting in fulminant hepatic failure requiring liver transplantation. J Infect. 2007;54:e115–e117.
Sobel HJ, Wolf EH. Liver involvement in early syphilis. Arch Pathol. 1972;93:565–568.
Keisler DS, Starke W, Looney DJ, et al. Early syphilis with liver involvement. JAMA. 1982;247:1999–2000.
Camara B, Kamar N, Bonafe JL, et al. Syphilis-related hepatitis in a liver transplant patient. Exp Clin Transplant. 2007;5:724–726.
Horn CL, Jalali S, Abbott J, et al. A surprising diagnosis: syphilitic gastritis and hepatitis. Am J Med. 2018;131:1178–1181.
Ridruejo E, Mordoh A, Herrera F, et al. Severe cholestatic hepatitis as the first symptom of secondary syphilis. Dig Dis Sci. 2004;49:1401–1404.
Mullick CJ, Liappis AP, Benator DA, et al. Syphilitic hepatitis in HIV-infected patients: a report of 7 cases and review of the literature. Clin Infect Dis. 2004;39:e100–e105.
Mandache C, Coca C, Caro-Sampara F, et al. A forgotten aetiology of acute hepatitis in immunocompetent patient: syphilitic infection. J Intern Med. 2006;259:214–215.
Rubio-Tapia A, Hujoel IA, Smyrk TC, et al. Emerging secondary syphilis presenting as syphilitic hepatitis. Hepatology. 2017;65:2113–2115.
Terry SI, Hanchard B, Brooks SE, et al. Prevalence of liver abnormality in early syphilis. Br J Vener Dis. 1984;60:83–86.
Fehér J, Somogyi T, Timmer M, et al. Early syphilitic hepatitis. Lancet. 1975;2:896–899.
Murphy CJ, Bhatt A, Chen W, et al. Syphilitic hepatitis. Lancet Gastroenterol Hepatol. 2017;2:920.
German MN, Matkowskyj KA, Hoffman RJ, et al. A case of syphilitic hepatitis in an HIV-infected patient. Hum Pathol. 2018;79:184–187.
Józsa L, Timmer M, Somogyi T, et al. Hepatitis syphilitica. A clinico-pathological study of 25 cases. Acta Hepatogastroenterol (Stuttg). 1977;24:344–347.
DeRoche TC, Huber AR. The great imitator: syphilis presenting as an inflammatory pseudotumor of liver. Int J Surg Pathol. 2018;26:528–529.
Baker AL, Kaplan MM, Wolfe HJ, et al. Liver disease associated with early syphilis. N Engl J Med. 1971;284:1422–1423.
Haburchak DR, Davidson H. Anorectal lesions and syphilitic hepatitis. West J Med. 1978;128:64–67.
Taxy JB, Cibull T. Syphilis: a contemporary clinicopathologic assessment. Am J Surg Pathol. 2020;44:1274–1281.
Baveja S, Garg S, Rajdeo A. Syphilitic hepatitis: an uncommon manifestation of a common disease. Indian J Dermatol. 2014;59:209.
Hussain N, Igbinedion SO, Diaz R, et al. Liver cholestasis secondary to syphilis in an immunocompetent patient. Case Rep Hepatol. 2018;2018:8645068.
Khambaty M, Singal AG, Gopal P. Spirochetes as an almost forgotten cause of hepatitis. Clin Gastroenterol Hepatol. 2015;13:A21–A22.
Mahto M, Mohammed F, Wilkins E, et al. Pseudohepatic tumour associated with secondary syphilis in an HIV-positive male. Int J STD AIDS. 2006;17:139–141.
Mulder CJ, Cho RS, Harrison SA, et al. Syphilitic hepatitis uncommon presentation of an old scourge. Mil Med. 2015;180:e611–e613.
Schlossberg D. Syphilitic hepatitis: a case report and review of the literature. Am J Gastroenterol. 1987;82:552–553.
Taliano RJ, Godfrey M, Garland J, et al. The great mimicker strikes again: an unusual case of syphilitic hepatitis with marked sinusoidal histiocytic infiltrate. AJSP Rev Rep. 2017;22:143–145.
Sabbatani S, Manfredi R, Attard L, et al. Secondary syphilis presenting with acute severe hepatic involvement in a patient with undiagnosed HIV disease. AIDS Patient Care STDS. 2005;19:545–549.
Keshtkar-Jahromi M, Rassaei N, Bruno MA, et al. A 59-year-old man with multiple liver lesions, rash, and uveitis. Clin Infect Dis. 2016;62:82–83; 123–124.
Yoshikawa K, Aida Y, Seki N, et al. Early syphilitic hepatitis concomitant with nephrotic syndrome followed by acute kidney injury. Clin J Gastroenterol. 2014;7:349–354.
Fielding CM, Angulo P. Right upper-quadrant pain in a patient with drug abuse, secondary syphilis and occult hepatitis B virus. Med Princ Pract. 2014;23:471–474.
Bork JT, Macharia T, Choi J, et al. Syphilitic hepatitis treated with doxycycline in an HIV-infected patient and review of the literature. Sex Transm Dis. 2014;41:507–510.
Kim M, Echevarria L, Savilo E. Photo quiz: a 38-year-old man with uveitis, cholestasis, and rash. J Clin Microbiol. 2013;51:1657.
Aggarwal A, Sharma V, Vaiphei K, et al. An unusual cause of cholestatic hepatitis: syphilis. Dig Dis Sci. 2013;58:3049–3051.
Lin H, Russo P, Rook M. Secondary syphilitic hepatitis in a 17-year-old girl. J Pediatr Gastroenterol Nutr. 2012;55:e134–e135.
Miura H, Nakano M, Ryu T, et al. A case of syphilis presenting with initial syphilitic hepatitis and serological recurrence with cerebrospinal abnormality. Intern Med. 2010;49:1377–1381.
Kim GH, Kim BU, Lee JH, et al. Cholestatic hepatitis and thrombocytosis in a secondary syphilis patient. J Korean Med Sci. 2010;25:1661–1664.
Noto P, Boumis E, Passarelli F, et al. An old disease makes a comeback. Liver Int. 2008;28:1417.
Wolf SC, Kempf VA, Tannapfel A, et al. Secondary syphilis after liver transplantation: case report and review of the literature. Clin Transplant. 2006;20:644–649.
Ishikawa M, Shimizu I, Uehara K, et al. A patient with early syphilis complicated by fatty liver who showed an alleviation of hepatopathy accompanied by jaundice after receiving anti-syphilitic therapy. Intern Med. 2006;45:953–956.
Jamieson A. Deranged liver function tests in type 1 diabetes mellitus: an unusual presentation of Treponema pallidum infection. Eur J Intern Med. 2003;14:113–115.
Ozaki T, Takemoto K, Hosono H, et al. Secondary syphilitic hepatitis in a fourteen-year-old male youth. Pediatr Infect Dis J. 2002;21:439–441.
Taniguchi Y, Nakae Y, Ikoma K, et al. Subclinical syphilitic hepatitis, which was markedly worsened by a Jarisch-Herxheimer reaction. Am J Gastroenterol. 1999;94:1694–1696.
Huang J, Lin S, Wang M, et al. Syphilitic hepatitis: a case report and review of the literature. BMC Gastroenterol. 2019;19:191.
Agrawal NM, Sassaris M, Brooks B, et al. The liver in secondary syphilis. South Med J. 1982;75:1136–1138.
Bhowmick BK, Simpsom B, Way SP. Secondary syphilis presenting jaundice. Postgrad Med J. 1975;51:412–416.
Solari PR, Jones C, Wallace MR. Hepatic lesions with secondary syphilis in an HIV-infected patient. Case Rep Med. 2014;2014:604794.
Matta B, Cabello R, Rabinovitz M, et al. Post-infantile giant cell hepatitis: a single center’s experience over 25 years. World J Hepatol. 2019;11:752–760.
Graham RP, Naini BV, Shah SS, et al. Treponema pallidum immunohistochemistry is positive in human intestinal spirochetosis. Diagn Pathol. 2018;13:7.