Syphilis Presenting as Hepatitis in an HIV-Infected Patient

Syphilis presents with protean manifestations. We report the case of a 24-year-old Filipino, working in Zambia for the past 2 months, presenting with a 2-week history of fever and jaundice. Maculopapular rashes were noted on both palms of the hands and both soles of the feet. Workup revealed an abnormal cholestatic pattern of liver function tests, while negative for malaria, viral hepatitis, and bacteremia. He tested positive for both HIV and VDRL (Venereal Disease Research Laboratory). A magnetic resonance cholangiopancreatography showed only hepatomegaly and no signs of cholangiopathy or hepatobiliary tree anomalies. After administration of a single dose of penicillin G, resolution of fever and jaundice and normalization of liver enzymes were noted. Syphilitic hepatitis was the primary diagnosis because of the following: demonstration of liver injury, positive serology for syphilis, and exclusion of other causes of liver injury with resolution upon penicillin G administration.