BMJ Case Reports 2018; doi:10.1136/bcr-2017-223023
  • Unusual association of diseases/symptoms

Syphilitic jaundice: a rare manifestation of the secondary stage presenting a missed opportunity to prevent ocular syphilis

  1. Stephen Peter Higgins2
  1. 1GU Medicine, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
  2. 2GU Medicine, Pennine Acute Hospitals NHS Trust, Manchester, UK
  1. Correspondence to Dr Joanne Curran, joflute{at}
  • Accepted 19 December 2017
  • Published 4 January 2018


The classical presentation of secondary syphilis comprises skin rashes, mucosal ulceration and lymphadenopathy. However, this disseminated stage can also present with symptoms and signs of ocular, neurological, pulmonary, renal, musculoskeletal and digestive tract disease. We report the case of a gay man who presented with icteric hepatitis. Although he underwent an exhaustive series of investigations (some of which were invasive), syphilis was not initially considered in the differential diagnosis. His jaundice resolved spontaneously, but he subsequently developed an acute optic neuritis. Early syphilis is relatively common in men who have sex with men (MSM). Prompt diagnosis and treatment in this case would have prevented ocular involvement. Syphilis testing should be considered in all MSM presenting with unexplained symptoms and signs.


  • Contributors Conception by SPH. Body of text written by JC and overseen by SPH.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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