A Stubborn Case of Syphilitic Hepatitis

Background Syphilitic hepatitis is a rare occurrence, but delay in its diagnosis can expose patient to unnecessary testing. The treatment available for this condition can also vary from one intramuscular injection of Penicillin G to a 2-weeks course of intravenous penicillin. Case presentation: A 53 years old male, presented for fever and abdominal pain, was found on physical examination to have a macular rash on the palms and soles, with fever and abdominal tenderness. Laboratory findings revealed AST 199 IU/L, ALT 132 IU/L, positive RPR, FTA-ABS and HIV antibodies test and a high HIV viral load. He was diagnosed with secondary syphilis and HIV co-infection. His hepatitis did not improve after intramuscular injection of penicillin G, his symptoms continued to worsen. A liver biopsy was done and revealed acute hepatitis and canalicular cholestasis, without evidence of treponemes. Patient was started on intravenous penicillin. He showed significant clinical improvement, and his LFT normalized. Conclusion: This case describes severe syphilitic hepatitis with unusual cytolytic disturbance of the liver function that failed to improve with one intramuscular penicillin injection. It demonstrates the need of intravenous penicillin therapy to achieve adequate clinical response, particularly in patients with severe laboratory evidence of liver inflammation.

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Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

Acta Facultatis Medicae Naissensis ◽

10.2478/v10283-012-0027-1 ◽

2012 ◽

Vol 29 (4) ◽

pp. 193-197 ◽

Cited By ~ 1

Author(s):

Milan Bjekić

Keyword(s):

Hair Loss ◽

Scalp Hair ◽

Secondary Syphilis ◽

Penicillin G ◽

Hiv Positive ◽

Oral Lesions ◽

Benzathine Penicillin ◽

Serological Tests ◽

Benzathine Penicillin G ◽

Macular Rash

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

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Secondary Syphilis

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.7.48515 ◽

2020 ◽

Vol 4 (4) ◽

pp. 675-676

Author(s):

Sarah Ehlers ◽

Shane Sergent ◽

John Ashurst

Keyword(s):

Emergency Department ◽

Maculopapular Rash ◽

Secondary Syphilis ◽

Mitigation Strategies ◽

Sexual Encounter ◽

Case Presentation ◽

Benzathine Benzylpenicillin ◽

Macular Rash ◽

Emergency Department Management ◽

Soles Of The Feet

Case Presentation: A 40-year-old male presented the the emergency department (ED) due to a diffuse body rash after a sexual encounter. Examination revealed a maculopapular rash that included the palms and soles of the feet bilaterally. A rapid plasma reagin was positive, and the patient was treated with 2.4 million units of benzathine benzylpenicillin intramuscularly. Diagnosis: Secondary syphilis can mimic many disease processes but classically presents as a painless macular rash on the palms of the hands and soles of the feet. Diagnosis is based upon clinical examination coupled with serological testing. Emergency department management should include 2.4 million units of benzathine benzylpenicillin intramuscularly and mitigation strategies.

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Secondary syphilis with unusual clinical and laboratory findings

Archives of Dermatology ◽

10.1001/archderm.99.2.240 ◽

1969 ◽

Vol 99 (2) ◽

pp. 240-243

Author(s):

L. Biro

Keyword(s):

Secondary Syphilis ◽

Laboratory Findings

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Secondary Syphilis With Unusual Clinical and Laboratory Findings

JAMA ◽

10.1001/jama.1968.03150040101027 ◽

1968 ◽

Vol 206 (4) ◽

pp. 889 ◽

Cited By ~ 15

Author(s):

Laszlo Biro

Keyword(s):

Secondary Syphilis ◽

Laboratory Findings

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Tissue Damage Caused by the Intramuscular Injection of Long-Acting Penicillin

PEDIATRICS ◽

10.1542/peds.75.4.741 ◽

1985 ◽

Vol 75 (4) ◽

pp. 741-744

Author(s):

Harry Schanzer ◽

Julius H. Jacobson

Keyword(s):

New Zealand ◽

Femoral Artery ◽

Normal Saline ◽

Tissue Damage ◽

Intramuscular Injection ◽

Penicillin G ◽

Left Femoral Artery ◽

New Zealand White Rabbits ◽

Long Acting ◽

The Right

In order to elucidate whether tissue damage produced on occasion by intramuscular injection of longacting penicillin is due to accidental intra-arterial injection or vasospasm, two types of experiments were carried out in rabbits. In the first set of experiments, six New Zealand White rabbits were given intra-arterial injections of 0.4 mL of a mixture containing 300,000 U of penicillin G benzathine and 300,000 units of penicillin procaine per milliliter (Bicillin C-R) into the left femoral artery and 0.4 mL of normal saline into the right femoral artery as autocontrol. In a second set of experiments, 0.4 mL of the same penicillin preparation was injected in the space surrounding the left femoral artery in five New Zealand rabbits, and 0.4 mL of normal saline was injected in a similar fashion around the right femotal artery as control. The legs of the rabbits that received the intra-arterial injection of penicillin invariably developed ischemic manifestations. None of the legs of rabbits given intra-arterial injections of normal saline had pathologic manifestations. None of the rabbits that received the periarterial penicillin preparation or normal saline developed abnormalities. These results strongly suggest that the tissue damage produced by penicillin is secondary to the intra-arterial administration of the drug.

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STUDIES OF PENICILLIN IN PEDIATRICS

PEDIATRICS ◽

10.1542/peds.5.4.664 ◽

1950 ◽

Vol 5 (4) ◽

pp. 664-671

Author(s):

B. M. KAGAN ◽

M. NIERENBERG ◽

D. GOLDBERG ◽

A. MILZER

Keyword(s):

Intramuscular Injection ◽

Room Temperature ◽

Serum Levels ◽

Sesame Oil ◽

Peanut Oil ◽

Penicillin G ◽

Procaine Penicillin ◽

Pertinent Data ◽

Significant Difference ◽

Pediatric Use

Table I summarizes most of the pertinent data in this report on the serum penicillin concentrations 12 and 24 hours after intramuscular injection of K penicillin G in peanut oil and beeswax, which is fluid at room temperature, and of three different procaine penicillin preparations. These three preparations are procaine penicillin G in sesame oil, procaine penicillin G in peanut oil with 2% aluminum monostearate, and procaine penicillin G in water with Na-carboxymethylcellulose. When they were given in a dosage of 8000 u./lb. to infants and children, weighing between 4.5 and 18.0 kg., there was no statistically significant difference in the serum levels obtained. A dosage schedule for these preparations is suggested for pediatric use. The aqueous preparation offers some advantages which are discussed. Experiences are reported which emphasize the necessity of avoiding intravenous administration of all these preparations.

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Case report: a 5-year-old with new onset nephrotic syndrome in the setting of COVID-19 infection

BMC Nephrology ◽

10.1186/s12882-021-02520-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kelsi M. Morgan ◽

Peace D. Imani

Keyword(s):

Nephrotic Syndrome ◽

Case Report ◽

Pediatric Patient ◽

Corticosteroid Therapy ◽

Clinical Remission ◽

Laboratory Findings ◽

Case Presentation ◽

The Third ◽

First Case ◽

New Onset

Abstract Background This is a case report of an asymptomatic SARS-CoV-2 infection associated with new-onset nephrotic syndrome in a pediatric patient. This is the third case of new-onset nephrotic syndrome in children associated with SARS-CoV-2 infection, but is the first case report describing a new-onset nephrotic syndrome presentation in a patient who had asymptomatic COVID-19 infection. Case presentation This is a case of a previously healthy 5 year old female who presented with new-onset nephrotic syndrome in the setting of an asymptomatic COVID-19 infection. She presented with progressive edema, and laboratory findings were significant for proteinuria and hypercholesterolemia. She was treated with albumin, diuretics, and corticosteroid therapy, and achieved clinical remission of her nephrotic syndrome within 3 weeks of treatment. Though she was at risk of hypercoagulability due to her COVID-19 infection and nephrotic syndrome, she was not treated with anticoagulation, and did not develop any thrombotic events. Conclusions Our case report indicates that SARS-CoV-2 infection could be a trigger for nephrotic syndrome, even in the absence of overt COVID-19 symptoms.

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Rheumatic Fever Article Questioned

PEDIATRICS ◽

10.1542/peds.74.6.1133a ◽

1984 ◽

Vol 74 (6) ◽

pp. 1133-1134

Author(s):

SYLVIA P. GRIFFITHS

Keyword(s):

Rheumatic Fever ◽

Intramuscular Injection ◽

Group A Streptococcus ◽

Penicillin G ◽

Benzathine Penicillin ◽

Benzathine Penicillin G ◽

Group A

To the Editor.— The suggestion of Nordin1 that there may be a need to re-evaluate the current recommended prophylaxis for children with rheumatic fever is valid, particularly if carefully planned and controlled studies could be carried out. However, the author's contention that "It has been assumed that the levels of penicillin [following monthly intramuscular injection of 1.2 million units of benzathine penicillin G] are adequate to prevent reinfection with group A streptococcus, and hence to prevent recurrences of rheumatic fever" has always been qualified by others.

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