The Great Imitator: Syphilitic Hepatitis Presenting as a Mimic to Autoimmune Liver Disease.
John Stanavage, Jared S Magee, Adam M Tritsch
✦ AI-curated · Sources linked
Case in brief
A 34-year-old male on PrEP for HIV presented with epigastric pain and constitutional symptoms. Laboratory tests showed elevated liver enzymes and positive smooth muscle antibodies, suggesting autoimmune hepatitis. However, syphilis screening returned positive, leading to treatment with benzathine penicillin G. Following treatment, the patient's liver function and autoimmune titers normalized.
What made this case unusual
This case highlights syphilis as a rare mimic of autoimmune hepatitis, presenting with positive autoantibodies, which is seldom documented.
Diagnostic / clinical pearl
Clinicians should consider syphilis in the differential diagnosis of liver disease, especially when autoimmune markers are present.
Why it matters
Recognizing syphilis as a potential mimic of autoimmune hepatitis can prevent misdiagnosis and ensure appropriate treatment.