All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Syphilitic hepatitis
Medical expert of the article
Last reviewed: 07.07.2025
Syphilitic hepatitis occurs in 4-6% of patients with late visceral syphilis. Syphilitic liver lesions can be congenital and acquired.
Symptoms of syphilitic hepatitis
Congenital syphilitic hepatitis
The clinical picture of congenital syphilitic hepatitis corresponds to chronic interstitial hepatitis of another etiology or liver cirrhosis. Jaundice is usually absent.
The child may be stillborn or die of spirochetal septicemia shortly after birth. Other (extrahepatic) manifestations of congenital syphilis come to the fore. Hepatosplenomegaly and, very rarely, jaundice are noted.
[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]
Acquired syphilitic hepatitis
Acquired syphilitic hepatitis develops as one of the forms of either early or late visceral syphilis.
Early syphilitic hepatitis manifests itself in anicteric forms with a simultaneous increase in the compacted liver and spleen.
In the secondary period of syphilis, liver damage is manifested by hysteria, skin itching and other symptoms of acute syphilitic hepatitis.
Late syphilitic hepatitis can occur in four forms: chronic epithelial, chronic interstitial, limited gummatous and miliary gummatous hepatitis.
- Symptoms of chronic epithelial hepatitis are non-specific: general malaise, pain and heaviness in the liver area, anorexia, nausea, vomiting, severe skin itching. The liver is slightly enlarged, protrudes 4-5 cm from under the edge of the costal arch, dense, but painless.
- Chronic interstitial hepatitis is characterized by intense pain in the liver, its enlargement, density during palpation, but jaundice is absent in the early stages of the disease. In the late period, when syphilitic cirrhosis of the liver develops, jaundice and severe itching of the skin join.
- Miliary gummatous hepatitis. Manifested by pain in the liver area, its uniform enlargement (with a smooth surface). The functional activity of the liver markers is maintained for a long time, and jaundice is usually absent.
- Limited gummatous hepatitis is accompanied by severe pain, fever, and chills. Hysteria of the sclera and skin, and other liver dysfunctions are expressed insignificantly; in the initial stages of the disease, jaundice occurs only as a result of mechanical obstruction of the bile ducts.
The clinical picture of gummatous hepatitis can imitate stomach or liver cancer, cholelithiasis, malaria, liver cirrhosis and other diseases. Patients complain of periodic pain in the right hypochondrium, which is cramping in nature. The pain often persists throughout the disease, sometimes only in the initial period. Body temperature can be normal or rise to 38 o C and sometimes even higher. The temperature curve often becomes irregular. An increase in body temperature is sometimes combined with chills. Fever and chills result from an exacerbation of inflammatory changes in the liver. The liver is enlarged, dense, lumpy, painful. In some cases, with the disintegration of peripheral gummas, softening of individual areas of the liver is palpated. Jaundice is a rare phenomenon. Its occurrence is explained by mechanical compression of large bile ducts by gumma. Portal hypertension and ascites are also rarely observed. The blood composition changes little. Only in severe cases of the disease is slight anemia detected. Moderate leukocytosis is often determined.
[ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ]
The course of syphilitic hepatitis
The course of syphilis of the liver in untreated cases leads to the death of the patient due to severe changes both in the liver and in other organs. Long-term intoxication in combination with fever and pain causing insomnia sharply exhausts patients. Death can occur with the phenomena of cachexia and intoxication. In other cases, death occurs from complications of cirrhosis, cholemia with compression of the bile ducts by scars, hepatargia, which can suddenly be superimposed on the previous course of the disease. Treatment of gummatous processes may not always lead to recovery; treatment is especially unsuccessful where cicatricial changes have already developed.
Syphilis can lead to serious complications in patients with HIV. A number of authors consider syphilitic hepatitis to be an HIV-associated disease.
Congenital liver lesions in syphilis
Congenital liver lesions in syphilis are interstitial hepatitis with connective tissue proliferation caused by multiple myloparous and gummas, which leads to an increase in the organ and gives it greater density. The liver structure is sharply disrupted, lobulation is not detected. The liver increases in size, becomes dense; a large number of spirochetes are found in it. Diffuse hepatitis develops, fibrosis occurs, and later - the formation of liver cirrhosis.
Early congenital syphilis. Histological examination of liver tissue reveals cholestasis, fibrosis and foci of extramedullary hematopoiesis.
Late congenital syphilis is now extremely rare. It is characterized by chronic inflammation and hypersensitivity reactions. Gummas may form in the liver.
[ 13 ]
Acquired syphilitic hepatitis
Acquired syphilis causes liver damage mainly in the tertiary period. Acute syphilitic hepatitis can also develop in the secondary period; it does not differ from acute hepatitis of other etiologies.
Syphilitic hepatitis is one of the forms of viscerosyphilis, in which damage to internal organs, including the liver, is observed.
A distinction is made between early and late liver lesions in visceral syphilis. Early syphilitic hepatitis is characterized by changes in liver function indices, disturbances in prothrombin and protein formation, and, less frequently, pigment function.
There are four forms of late syphilitic hepatitis: chronic epithelial, chronic interstitial, limited gummatous and miliary gummatous. All forms are characterized by a long course of the process with gradual development of sclerogummous changes leading to cirrhosis and liver deformation.
Chronic epithelial hepatitis occurs in the tertiary period of syphilis, when the phenomena of hyperergic reactivity increase. In the tertiary period of syphilis, when the phenomena of hyperergic reactivity increase, chronic epithelial hepatitis occurs secondarily or spontaneously.
Chronic syphilitic interstitial hepatitis develops as a result of diffuse proliferative damage to the cells of the interstitial tissue. Just like epithelial hepatitis, it can form in the secondary period as a result of direct penetration of pale treponemas.
Miliary gummatous hepatitis is characterized by the formation of nodular infiltrates. Liver hypertrophy in gummatous hepatitis is characterized by unevenness, tuberculosis, and lobulation. Miliary gummas are small in size, located around vessels, and affect liver tissue less.
Limited gummatous hepatitis is characterized by the formation of large nodes involving secretory and interstitial areas. A zone of perifocal nonspecific inflammation forms around the gummas. In the final stages, pronounced sclerogummatous atrophic, deforming scars are observed.
In the tertiary period of syphilis, gummatous liver damage most often develops, sometimes occurring decades after infection. The pathological process is the result of the introduction of pale spirochetes into the liver, entering this organ through the hematogenous route. Morphological changes are reduced to the formation of gummas of various sizes in the liver, usually located in the peripheral parts of the liver (upper or lower surface of the liver, anterior edge). Located on the lower surface of the liver near its gates, gummas can cause a violation of the blood supply to the organ and bile secretion. Histologically, gumma is an infiltrate consisting of lymphocytes, eosinophils, plasma and sometimes giant cells, around which the number of small vessels increases and connective tissue grows. The central areas of gummas often become necrotic, disintegrate and suppurate, and scar tissue forms at the site of disintegration. Gummatous changes in the peripheral parts of the liver lead to the development of perihepatitis. The outcome of gummatous hepatitis is syphilitic lobular liver,
Diagnosis of syphilitic hepatitis
The diagnosis is made on the basis of anamnestic data on syphilis and the use of specific antisyphilitic therapy in the past for clinical manifestations; detection of a positive Wasserman reaction. However, a negative Wasserman reaction does not exclude syphilitic hepatitis. Decisive significance is attached to the data of the immunofluorescence reaction, the pale treponema immobilization reaction, as well as ELISA, RIGA, microprecipitation reaction and the results of trial treatment.
When diagnosing syphilis of the liver, it is necessary to conduct differential diagnostics with stomach or liver cancer, chronic hepatitis of other etiologies, malaria, and portal cirrhosis of the liver.
The prognosis of the disease depends on the stage and extent of the process. With a small number of gummas, the prognosis is favorable, since gummas can undergo resorption and scarring under the influence of specific therapy. With multiple and large gummas, the outcome is questionable. With pronounced gummatous changes, severe complications can develop: portal hypertension with bleeding from varicose veins of the gastrointestinal tract, perihepatitis with the transition of inflammation to neighboring organs. Suppuration of gummas can serve as a source of purulent diseases of other organs (subphrenic abscess, encapsulated purulent peritonitis).
Treatment of syphilitic hepatitis
A course of antisyphilitic treatment is carried out with iodine, mercury, benzylpenicillin preparations, intramuscular injections of biyoquinol 1-2 ml every other day (20-30 ml per course). The use of salvarsan preparations, which have a toxic effect on the liver, should be avoided.
Since the liver damaged by syphilitic infection is particularly sensitive to specific agents, the question of antisyphilitic treatment is extremely complex. The most favorable treatment is gummatous liver lesions. The main agents are iodine and mercury. Salvarsan should be used with great caution. It is advisable to conduct insulin and glucose treatment in parallel with specific therapy.
Adequate penicillin therapy over a long period of time leads to a reduction in the number of lesions.
Prevention of syphilitic hepatitis
Prevention of syphilitic hepatitis consists of preventing sexually transmitted diseases and proper treatment of syphilis.