P0746 - The ABC's: A Case of Hepatitis A, B, and C Infection With Autoimmune Hepatitis and Neurosyphilis Co-Infection

Christopher Millet, MD¹, Alisa Farokhian, MD, BS², Alman Khalid, MD³, Nader Mekheal, MD⁴, Gabriel Melki, MD⁵, Abdalla Mohamed, MD⁶, Walid Baddoura, MD^3
1St. Joseph University Medical Center, Paterson, NJ; ²St. Joseph's Regional Medical Center, Paterson, NJ; ³St. Joseph's University Medical Center, Paterson, NJ; ⁴St. Joseph University Medical Center, Wayne, NJ; ⁵St. Joseph Regional Medical Center, Paterson, NJ; ⁶St. Joseph's Hospital and Medical Center, Paterson, NJ

Introduction: Hepatitis is caused by a variety of etiologies including infectious, autoimmune and drug induced. Syphilis is caused by the bacteria treponema pallidum, which can spread to different organs including the liver. We present a case of a male with a history of hepatitis c, who presented with acute hepatitis A and B, autoimmune hepatitis (AIH) and syphilitic hepatitis.

Case Description/Methods: A 50-year-old male with history hepatitis C presented to the ED with abdominal pain of 2 weeks duration. The pain was associated with increasing abdominal girth, and a rash on his hands and feet. The patient was homeless and had engaged in sexual activity with prostitutes for several years. Physical exam findings included jaundice, scleral icterus, abdominal distention, papular lesions on his palms and soles and a painless chancre on his scrotum. Laboratory findings showed elevations in AST, ALT, Alkaline phosphatase, total bilirubin and ammonia. CT scan of the abdomen revealed hepatosplenomegaly with varices and ascites. A hepatitis profile was positive for hepatitis A IgM, hepatitis B surface antigen (Ag), hepatitis B core antibody (Ab) total, hepatitis B core Ab IgM, hepatitis Be Ag, hepatitis C Ab, and Anti smooth muscle Ab. RPR was positive with a titer of 1: 64. Fluorescent treponemal Ab absorption test was positive confirming the diagnosis of syphilis. The patient was admitted to the medical floors, received therapeutic paracentesis and was initiated on furosemide and spironolactone. CSF analysis revealed a positive VDRL test. CT guided needle biopsy of the liver was performed which revealed dense lymphoplasmocytic infiltrate with scattered eosinophils in the portal areas, prominent cholestasis with bile ductular proliferation; immunostaining for treponema pallidum was negative. The patient was given penicillin G 4,000,000 units every 4 hours IV for 10 days. The patient exhibited improvement of his symptoms however left against medical advice prior to completion of his antibiotic therapy.





Discussion: Our patient presented with multiple etiologies of hepatitis occurring simultaneously including acute hepatitis A and B, and chronic hepatitis C infection. The biopsy exhibited anti- smooth Ab and lymphoplasmocytic infiltrate of the portal system with eosinophils which are suggestive of AIH as well. While the biopsy did not reveal treponema
pallidum organisms, infiltration of the portal system with inflammatory cells and cholestasis has been described in many case reports of syphilitic hepatitis.


Disclosures:


Christopher Millet, MD¹, Alisa Farokhian, MD, BS², Alman Khalid, MD³, Nader Mekheal, MD⁴, Gabriel Melki, MD⁵, Abdalla Mohamed, MD⁶, Walid Baddoura, MD³. P0746 - The ABC's: A Case of Hepatitis A, B, and C Infection With Autoimmune Hepatitis and Neurosyphilis Co-Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.