Secondary syphilis: decompensation factor of underlying liver disease? A clinical case

Abstract

Introduction: Syphilis is a notifiable infection, mostly sexually acquired, caused by the bacterium Treponema pallidum. Clinical manifestations vary on the stage of the disease: early syphilis, (primary and secondary disease) and late syphilis (latent or tertiary). The secondary disease is systemic and develops within weeks or a few months, in approximately 1/4 of individuals with untreated primary infection. At this stage, the illness may appear as constitutional symptoms, adenopathies, macular or papular rash including palms and soles, and hepatic, renal, or neurological manifestations, among others. Serologic testing provides a presumptive diagnosis, therefore nontreponemal and treponemal-specific tests are needed for the diagnosis of syphilis. The difficult interpretation of the serologic findings allied to a wide variety of signs and symptoms and an increasing incidence in the last years challenge the diagnosis of this disease.

Case description:  The authors describe a clinical case of an adult who appears with swollen lower limbs, fatigue, and the perception of abdominal distension. Objectively, exhibits erythematous maculopapular lesions, with peripheral desquamation, non-pruritic, on the palms and soles. After a complete clinical interview, the hypothesis of decompensation of liver disease in the context of secondary syphilis/syphilitic hepatitis is raised and the patient is sent to the Emergency Department, where the infection is confirmed.

Comment: This case report demonstrates the challenge of diagnosing syphilis due to the wide variety of clinical manifestations. Once the diagnosis of syphilis, treatment is curable simply with an only-dose injection of penicillin, preventing severe consequences due to systemic disease. In summary, a family doctor must be capable of recognizing this infection and acquainted with the serologic tests that may be used and the recommended treatment.