The "Great Imitator." Syphilis as Causative Agent of Isolated, Concurrent, Acute Hepatitis and Meningitis

Abstract

The first described case of acute concurrent hepatitis and meningitis as the isolated mode of presentation of syphilis in an HIV-infected homosexual man undergoing antiretroviral therapy is presented and discussed, on the ground of literature evidences and relevant epidemiological, diagnostic, therapeutic, and public health implications. A negligible epidemiological and medical history and the absence of other signs and symptoms of syphilis delayed the diagnosis, which was later confirmed through associated positive serum and cerebrospinal fluid syphilis serology. Histopathologic studies of the liver were also performed, as well as brain computed tomography scan. High-dose intravenous penicillin administration led to a rapid cure of both complications. When facing young patients with some signs and symptoms of hepatic and meningeal involvement, a syphilitic etiology should not be underestimated, especially when concurrent conditions (HIV disease and antiretroviral therapy in our case) may render differential diagnosis even more difficult. The recent resurgence of syphilis also focuses important public health issues, as a sign of a reduced attention to barrier preventive measures against sexually transmitted diseases.