Severe acute syphilitic hepatitis

We report the case of a 23-year-old patient with very marked hepatic cytolysis (ASAT: 18N; ALAT: 44N) associated with biological icterus and mucocutaneous jaundice. Initially, no etiology was identified due to the absence of toxic consumption, the negativity of hepatotropic virus serologies and tests for autoimmune pathologies. Following the appearance of cutaneous signs three weeks after the onset of hepatic involvement, a syphilis serology was performed, which proved positive and led to the diagnosis of secondary syphilis. To our knowledge, only one case of hepatic syphilis with such intense hepatic cytolysis has been described. Usually, the hepatic damage is moderate, with transaminases not exceeding 5 times normal values. Syphilitic hepatitis is rare and occurs in less than 10% of syphilis cases. This case makes it possible to identify syphilis as a neglected etiology of acute hepatitis which should be considered in a context suggestive of infection even in the absence of skin signs.