Aetiology of Post-arsphenamine Jaundice

Abstract

Damage to the liver parenchyma, with or without icterus, can occur at any stage of untreated syphilis, acquired or prenatal. Icterus is rare in early acquired syphilis, and when it appears is usually coincident with secondarv manifestations, original or relapse. The liver biopsy findings in cases of jaundice in untreated secondary syphilis are indistinguishable from those seen in cases of post-arsphenamine jaundice. Liver material from untreated secondary syphilitics who show no clinical signs of liver damage is quite normal. Jaundice in untreated cases, though of some interest, is of less importance than the icterus which appears after arsenical treatment has been started. This type of frequently referred to as post-arsphenamine jaundice, differs from the jaundice of untreated early syphilis in certain respects. In the latter type the use of arsphenamines in treatment is, in our experience, without danger and leads to a rapid clearing of the icterus. This is not so in the case of post-arsphenamine jaundice. Although many cases have been described in which arsenical treatment has been continued through post-arsphenamine we are convinced that such a policy is dangerous. The administration of arsenic before clinical and biochemical recovery in some such cases has produced alarming evidence of increased liver damage. Milian (1934), who believed that the delayed jaundice of arsphenamine treatment is due not to the drug but to a hepatic recurrence of syphilis, continued to treat 75 cases with arsphenamine, and claimed satisfactory results in 66. Of the remainder, 11 were intolerant and 4 died. Goodman and Gilman (1941) thought that jaundice during arsphenamine treatment may be due to one or a combination of the following factors-the drug, syphilis itself, or intercurrent infection. The evidence is convincing that many cases represent attacks of non-specific catarrhal jaundice occurring in patients whose livers are subjected to the added insults of syphilis and an arsenical. Mitchell (1943), reporting on jaundice in syphilitics under treatment in the Canadian Army in Great Britain, suggested that jaundice is due to the association of two hepatoxic agents-the arsenic and the agent or toxin of infectious hepatitis in patients under arsenotherapy. These two opinions imply that the infectious hepatitis or non-specific catarrhal jaundice (other synonyms-toxic hepatitis, non spirochaetal epidemic simple acute catarrhal jaundice) associated with arsenical treatment in syphilitics is identical with that which produces jaundice so frequently in the normal population and which has become so prevalent in recent years. Two Types of Hepatitis