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April 9, 1982

Early Syphilis With Liver Involvement

JAMA. 1982;247(14):1999-2000. doi:10.1001/jama.1982.03320390061045

SECONDARY syphilis of the liver is a treatable disease that may have unusual manifestations. Often, the disease is difficult to diagnose, requiring expensive testing and delaying initiation of therapy.1-4 The finding of a spirochete on liver biopsy is diagnostic, but rare; only two authors have published photographic documentation of spirochetes in the liver.5,6 Other less-invasive test results may also suggest secondary involvement of the liver. We describe a patient with typical serological and laboratory findings who was treated successfully for secondary syphilis of the liver after a biopsy specimen disclosed a rare spirochete in the portal tracts.

Report of a Case  A 27-year-old homosexual man was admitted to the hospital for evaluation of epigastric pain and elevated serum alkaline phosphatase levels. Ten days earlier, he had had dull, intermittent epigastric pain that was exacerbated by eating and bending over. He denied nausea, vomiting, jaundice, or fever. He had