Early syphilitic hepatitis with diffuse intrahepatic biliary strictures: A case report

The patient was a woman in her 40s who was working at a brothel. She came to our hospital with a chief complaint of a vulvar mass. We suspected syphilis based on the cutaneous findings and a positive RPR test. Se-rum hepatobiliary enzymes were elevated, and biliary tract enzymes were significantly high. Abdominal imaging showed fatty changes around the portal veins and diffuse intrahepatic biliary strictures. Liver biopsy showed lymphocytic infiltration and fibrosis around the Glissonʼs sheath and fatty degeneration in the paren-chyma. After prescribing AMPC, the blood test and imaging findings improved over the course of approxi-mately 11 months. Among the past reports of early syphilitic hepatitis, only a few have shown biliary abnormali-ties on imaging. In contrast, our case demonstrated characteristic bile duct imaging findings that were consis-tent with the features of early syphilitic hepatitis, which mainly affects the biliary system.