title: Tertiary syphilis presenting as hepatic bull's eye lesions.
abstract: We report a rare case of tertiary syphilis (hepatic gummata, asymptomatic neurosyphilis and iridocyclitis) in a 47 year old female patient. Our patient suffered from a troubled sight, pain in the right hypochondrium, one enlarged submandibular lymph node, an elevated sedimentation rate, disturbed liver tests and two hepatic lesions upon abdominal computed tomography. The diagnosis was based upon a liver biopsy and a positive Treponema Pallidum haemagglutination test. The patient was treated with doxycyclin. After treatment the sedimentation rate and liver tests normalised and the hepatic lesions disappeared leaving a small 'scar' on CT-scan; at the end she still complained of a decreased sight. We conclude that syphilitic gummata of the liver have a favourable prognosis when the diagnosis is made early. One has to differentiate with hepatic abscesses, primary tumours and metastases.
authors.affiliation: Department of Gastroenterology, H Hart Hospital, Lier, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Peeters
authors.forename: W
authors.initials: W
authors.lastname: Van Vaerenbergh
authors.forename: C
authors.initials: C
authors.lastname: Van der Perre
authors.forename: W
authors.initials: W
authors.lastname: Lagrange
authors.forename: M
authors.initials: M
authors.lastname: Verbeke
mesh_terms: D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008111:Liver Function Tests; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy; D013588:Syphilis Serodiagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D004318:Doxycycline