Syphilitic Hepatitis: An Atypical Presentation of a Familiar Foe

Syphilitic hepatitis is a rare diagnosis with a reported incidence of 0.2% to 9.7%. Here, we present a case of a young man with acute liver injury and a maculopapular rash involving the trunk, limbs, palms, and soles. Extensive work-up led to a diagnosis of syphilitic hepatitis with high rapid plasma reagin titer and an atypical elevation in transaminases and bilirubin. The patient was treated with benzathine penicillin with a good response. This atypical presentation emphasizes the importance of having a high clinical index of suspicion for syphilis as a cause for acute hepatitis.