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WCID 2024

Karthic Drishna Perumal

Karthic Drishna Perumal, Speaker at Infectious Diseases Conferences
Mount Carmel Health, United States
Title : Syphilitic hepatitis: A rare case of hepatic injury from a commonly transmitted venereal disease


Syphilis is a sexually transmitted disease caused by the non-hepatotropic spirochete Treponema pallidum. The disease is typically divided into early (primary and secondary infection) and late (tertiary infection that can be symptomatic or asymptomatic) stages. Syphilitic hepatitis is a rare complication of an early-stage infection characterized by a cholestatic pattern of liver injury not explained by any other causes of hepatic insult and resolution of symptoms and transaminitis with antibiotic treatment.

The mainstay of treatment for primary and secondary syphilis is a single injection of long-acting Benzathine penicillin G. However, patients who suffer from hypersensitivity or severe allergic reactions such as anaphylaxis with penicillin might require alternative antibiotic therapies. We present a case of a 43-year-old Caucasian female who presented to the emergency department with abdominal pain, nausea, and continued constipation after multiple treatment attempts in past visits to the hospital. She was afebrile and hemodynamically stable on presentation with a physical exam remarkable for a diffuse, macular, and pruritic rash that was noticed over the chest, arms, and legs; progressively worsening abdominal pain reported in the right upper and left lower quadrants; and bilateral tender inguinal lymph nodes, approximately 3 cm in size.

The patient’s laboratory tests were significant for leukocytosis, elevated transaminases, alkaline phosphatase, gamma-glutamyl transpeptidase, hyperbilirubinemia, and positive quantitative RPR for syphilis. Ultrasound and CT of the abdomen and pelvis were both nondiagnostic for any acute hepatic and gallbladder pathologies or processes. Due to a history of hypersensitivity allergic reactions from penicillin, the patient was started on doxycycline and experienced significant recovery of symptoms and aminotransferases on subsequent laboratory follow-ups. Our patient case explores the diagnostic strategies involved in a rare complication of a common sexually transmitted disease and highlights a novel and unorthodox treatment strategy employed in the management of syphilitic hepatitis.

Audience Take Away: 

  • Audience can learn a different possible presentation for Syphilis, rare form of syphilitic hepatitis
  • Audience can learn potential alternate diagnostic solutions for syphiltic hepatitis
  • Audience can learn potential diagnostic criteria for rare presentation of syphilitic hepatitis
  • Audience can learn an alternative treatment for to penicilin with syphilis



Dr. Perumal studied at Northeast Ohio Medical University as part of a 6 year accelerated BS/MD program and graduated in 2022. He then joined Mount Carmel Health system and currently works as a first year resident physician in the Internal Medicine department.


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