Background: Syphilis is a common disease that has been researched and focused on for many years, however,\nsyphilitic hepatitis has not been well-recognized. We report this case of syphilitic hepatitis with intrahepatic\ncholestasis and liver granulomas to make a deeper impression.\nCase presentation: A 47-year-old male was admitted with jaundice and rashes. The laboratory examination\nshowed abnormal liver enzymes with significant increases in ALP and GGT but mild increases in ALT and AST. His\nHBV surface antigen was weakly positive, with negative HIV antibody, HCV antibody, and undetectable HBV DNA.\nThe rapid plasma reagin test and the Treponema pallidum particle assay tests for Syphilis were both positive.\nAbdominal ultrasonography and magnetic resonance cholangiopancreatography revealed the normal biliary tract,\nliver, and spleen. The liver pathological examination showed cholangiocyte inflammation and micro-granulomas\nwith coagulation necrosis. After 2 months of benzathine penicillin treatment, his liver enzyme decreased rapidly and\nremained normal after 1-year of follow-up.\nConclusions: Increased liver enzymes, intrahepatic cholestasis and liver granulomas with well-response to antibiotics\nmay provide clues for the diagnosis of syphilitic hepatitis.
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