title: [Tertiary syphilis with liver gummata].
abstract: Sonography revealed multiple echo-poor lesions in the liver of a 51-year-old man with nonspecific symptoms (fatigue, drop in performance, pressure sensation in the upper abdomen), increased blood sedimentation rate (68/110 mm) and evidence of cholestasis (gamma-GT 126 U/l, alkaline phosphatase 444 U/l, leucine-aminopeptidase 64 U/l). Under the diagnosis of liver metastases the primary tumour was looked for. These investigations and a fine-needle biopsy having proved unsuccessful, laparoscopy was performed. The biopsies so obtained showed whitish yellow, tight elastic structures indicating gummas of the liver in tertiary syphilis. Treponema-specific IgM antibodies in serum characterized active syphilis requiring treatment. Administration of antibiotics (penicillin 1 mega U daily i.m.; because of allergy replaced after four days by erythromycin 2 g daily for six weeks) resulted in complete normalization of all biochemical findings and, some time later, regression of the gummas. The patient has now been symptom-free for three years. This case illustrates the need even to-day of including syphilis in the differential diagnosis of unclear space-occupying lesions of the liver.
authors.affiliation: Medizinische Poliklinik, Universität Würzburg.
authors.forename: W
authors.initials: W
authors.lastname: Fischbach
authors.forename: J
authors.initials: J
authors.lastname: Mössner
authors.forename: J
authors.initials: J
authors.lastname: Dämmrich
authors.forename: M
authors.initials: M
authors.lastname: Jenett
mesh_terms: D001706:Biopsy; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004917:Erythromycin / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010406:Penicillins / Q000008:administration & dosage; D012074:Remission Induction; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013588:Syphilis Serodiagnosis; D014463:Ultrasonography
chemical_list: D010406:Penicillins; D004917:Erythromycin
vernacular_title: Tertiäre Lues mit Lebergummen.