Case of unusual presentation of a sexually transmitted infection.
This article describes the case of a 67-year-old patient with syphilitic hepatitis, an unusual presentation of a sexually transmitted infection. The patient was admitted to the hospital for progressive liver enzyme elevation with abdominal pain, decreased appetite and fatigue. His medical history revealed that his symptoms began three months before his admission. Laboratory tests further revealed elevated transaminases.
Initial evaluation ruled out autoimmune hepatitis, Wilson’s disease, primary biliary cirrhosis, alpha-1 antitrypsin deficiency and viral hepatitis. لعبة بينغو Subsequently, weakness and numbness developed distal to his axillae, progressing to his torso and lower extremities. Symptoms in his lower extremity worsened, leading to ataxia. Moreover, he could no longer walk without support. The patient was advised neurologic workup for ataxia, weakness and low back pain 2 months after his symptoms first appeared. Imaging of the head, brain and spine did not show any significant findings.
History and examination
On presentation, the patient appeared anorexic with edema in his lower extremity and rusty coloured urine. Other presenting signs included episodes of “sharp” pain in his back, groin and legs that lasted for several minutes to an hour. Examination also revealed a 10-day history of a nonitchy painless rash that began on his arms and spread to his torso, palms and thighs. الرهان في سباق الخيل His past medical history of insignificant. كازينو اونلاين He had no history of alcohol, tobacco or drugs use. However, he admitted to being in sexual relationships with 5 to 10 male partners in the past. In addition, he had no recent travel history, use of herbal supplements or antibiotics.
Physical examination was further remarkable of a diminished sensation in his bilateral lower extremities on pinprick and light touch, bilateral pitting lower extremity oedema and mild scleral icterus. The patient’s skin showed a nontender maculopapular rash that was most notable on the scalp, chest, thighs and palms. Similarly, a nontender chancre, measuring 1 to 2 cm was also found on his posterior penile shaft.
The presence of dermatologic, hepatic and neurologic signs and symptoms pointed to the differential diagnosis of syphilis. Doctors advised a liver biopsy Whereas the patient was positive for HIV. Liver pathology showed macrovesicular and microvesicular steatosis with focal hepatocellular ballooning and Mallory–Denk bodies, patchy PAS-D positive cytoplasmic hyaline globules, and periportal and sinusoidal fibrosis.
The findings were consistent with the diagnosis of syphilitic hepatitis. Treatment with Penicillin G showed remarkable improvement in his liver enzyme.
References
Spirochetes in the Liver: An Unusual Presentation of a Common STI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927064/
