Syphilitic hepatitis uncommon presentation of an old scourge.
BACKGROUND
Giant cell hepatitis is a rare entity in adults, accounting for 0.1% to 0.25% of liver disease in adults. Postinfantile giant cell hepatitis is often characterized by multinucleated giant cells on liver biopsy and a fulminant hepatitis.


METHODS
An active duty 36-year-old African-American male deployed to Kabul, Afghanistan, presented with jaundice 2 weeks after starting a testosterone analogue. He discontinued the supplement, but his jaundice persisted with up-trending bilirubin. Serologic testing was negative for hepatitis A, B, C, and E; cytomegalovirus; Epstein-Barr virus; herpes simplex virus; and human immunodeficiency virus. Evaluation for autoimmune hepatitis was negative. Magnetic resonance cholangiopancreatography was negative for obstruction. Liver biopsy revealed giant cell transformation of numerous hepatocytes and cholestatic hepatitis. Rapid plasma reagin was positive without physical findings. Treponema pallidum hemagglutination assays confirmed the diagnosis of latent syphilis. He was started on penicillin treatment with rapid improvement of bilirubin, creatinine, and hepatic synthetic function, all of which eventually normalized.


CONCLUSIONS
Postinfantile giant cell hepatitis is a severe form of hepatitis that has several different potential etiologies, 2 of which were present in this patient: androgenic supplements and infection. This case highlights syphilis as an unusual but treatable cause of giant cell hepatitis. Testing for syphilis should be considered in any persistent liver injury.
Department of Gastroenterology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Christopher J
CJ
Mulder
Department of Internal Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Ryan S
RS
Cho
Department of Gastroenterology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Stephen A
SA
Harrison
Department of Pathology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Katherine
K
Cebe
Department of Gastroenterology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
James M
JM
Francis
D000328:Adult; D015726:Giant Cells / Q000473:pathology; D006505:Hepatitis / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008889:Military Personnel; D013592:Syphilis, Latent / Q000150:complications* / Q000175:diagnosis; D014481:United States