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Luetic (syphilitic) hepatitis: the great imitator persists in the 21st century
  1. Daniel Mullally,
  2. Sreelakshmi Kotha,
  3. Mandour Omar Mandour and
  4. Philip Berry
  1. Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sreelakshmi Kotha; sreelakshmi_kotha{at}


A male patient in his 20s was referred to the hepatology team with jaundice, pruritus and drenching night sweats. Investigations revealed an acute hepatitis with negative autoimmune and viral serology. Liver biopsy demonstrated severe pan-lobular hepatitis, and an extended diagnostic screen included a positive treponemal antibody test, with an RPR titre of 64, indicating active syphilis infection. He was treated with 2.4 million units of intramuscular benzathine penicillin as a single dose which led to complete resolution of the abnormal liver tests and symptoms. Diagnostic and management challenges, including the role of good history taking, appropriate investigations and role of multidisciplinary team, are discussed.

  • Liver disease
  • Hepatitis other

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  • Contributors DM: management and writing case. SK: management and writing case. MOM: management and writing case. PB: management and writing case. DM, SK, MOM and PB: final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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