A case of early syphilitic hepatitis that was rapidly cured by a single intramuscular injection of a continuous penicillin preparation

Abstract

A male patient in his 50s who complained of general malaise, itchy skin, and brown urine was admitted to our hospital. Both hepatitis virus markers and autoantibodies were negative. He developed a rash that appeared on his limbs and trunk, a thorough history revealed two months of contact with the sex business, raising the possibility of syphilis infection. Early-stage syphilis (stage 2) and early-stage syphilitic hepatitis were determined to exist. A single-dose benzylpenicillin benzathine hydrate (BPB) intramuscular injection, newly available in Japan since January 2022, and suitable for early treatment of syphilis, was administered. The rash and liver failure and syphilis were all quickly resolved. Although uncommon, early-stage syphilitic hepatitis should be taken into account as a possible cause of liver damage. No earlier publications have used intramuscular BPB injection as a treatment for early-stage syphilitic hepatitis in Japan, hence we present this case together with a literature review.