Syphilis may involve the liver in congenital, secondary and tertiary stages. One manifestation is a cholangiopathy that may mimic sclerosing cholangitis.
Clinical findings:
(1) variable jaundiced
(2) cholangitis
(3) variable lymphadenopathy
(4) variable macular erythematous rash (in secondary syphilis)
(5) variable pharyngitis
Laboratory findings:
(1) elevated serum bilirubin
(2) elevated ALT
(3) elevated serum alkaline phosphatase
(4) serologic evidence of syphilis
A liver biopsy may show spirochetes in the portal tracts in patients with secondary syphilis.
Histologic features:
(1) vasculitis in the portal tracts
(2) cholangitis
(3) paucity of intrahepatic bile ducts
The diagnosis requires exclusion of other causes of cholangiopathy including HIV.
The diagnosis is supported by clinical improvement after starting therapy for syphilis.
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