Syphilitic hepatitis

Syphilitic hepatitis occurs in 4-6% of patients with late visceral syphilis. Syphilitic lesions of the liver 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 cirrhosis of the liver. Jaundice as a rule, does not happen.

A child may be stillborn or die from spirochectomy septicemia shortly after birth. At the forefront are other (extrahepatic) manifestations of congenital syphilis. There is hepatosplenomegaly and, very rarely, jaundice.

[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 is manifested by 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: in the form of chronic epithelial, chronic interstitial, limited gummy and miliary hematosis.

• Symptoms of chronic epithelial hepatitis are nonspecific: general malaise, pain and heaviness in the liver, anorexia, nausea, vomiting, severe itching. The liver is slightly enlarged, protrudes 4-5 cm from under the edge of the costal arch, is dense, but painless.
• For chronic: interstitial hepatitis is characterized by intense pain in the liver, its increase, density in palpation, but jaundice is absent in the early stages of the disease. In the late period, when syphilitic cirrhosis develops, jaundice and severe itching of the skin join.
• Miliary hummoxic hepatitis. Is manifested by pain in the liver, its uniform increase (with a smooth surface). The functional activity of the liver markers persists for a long time, and jaundice is usually absent.
• Limited gummy hepatitis is accompanied by severe pain, fever, chills. Hysterical sclera and skin, other disorders of liver function are expressed slightly; in the initial stages of the disease, jaundice occurs only as a result of mechanical obstruction of the bile ducts.

The clinical picture of gummy hepatitis can mimic cancer of the stomach or liver, cholelithiasis, malaria, liver cirrhosis and other diseases. Patients complain of periodic pain in the nature of the hypochondrium, which have a cramping character. Pain often stays throughout the course of the disease, sometimes only in the initial period. Body temperature can be normal or rise to 38 ^o C and sometimes more. Often the temperature curve becomes irregular. A rise in body temperature is sometimes combined with chills. Fever and chills are the result of an exacerbation of inflammatory changes in the liver. The liver is enlarged, dense, tuberous, painful. In some cases, the disintegration of peripheral gumm palpatorically determines the softening of individual areas of the liver. Jaundice is a rare occurrence. Its origin is explained by mechanical compression of large bile ducts with gum. Seldom observed, portal hypertension and ascites. The composition of the blood varies little. Only in severe cases do they detect a small anemia. Often determined by moderate leukocytosis.

[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 in the liver, hack and other organs. Long-term intoxication in conjunction with fever and pain causing insomnia, dramatically drains patients. Death can occur with the phenomena of cachexia and intoxication. In other cases, death comes from the complications of cirrhosis, cholemia with scarring of the bile ducts, hepatarga, which can suddenly build up on the previous course of the disease. Treatment of gummy processes can not always lead to recovery; in particular, unsuccessfully treatment where cicatricial changes have already developed.

Syphilis can lead to serious complications in patients with HIV. A number of authors consider syphilitic hepatitis an HIV-associated disease.

Congenital liver damage with syphilis

Congenital liver damage with syphilis is an interstitial hepatitis with a proliferation of connective tissue, caused by multiple mils paired and gammas, which leads to an increase in the organ and gives it a greater density. The structure of the liver is severely disrupted, lobulation is not detected. The liver increases, becomes dense; it shows a large number of spirochaetes. Diffuse hepatitis develops, fibrosis occurs, and later - the formation of liver cirrhosis.

Early congenital syphilis. When histological examination of liver tissue, cholestasis, fibrosis and foci of extramedullary hematopoiesis are detected.

Late congenital syphilis is currently extremely rare. It is characterized by chronic inflammation and hypersensitivity reactions. In the liver, gums can form.

[13]

Acquired syphilitic hepatitis

Acquired syphilis causes liver damage mainly in the Tertiary period. Acute syphilitic hepatitis can develop in the secondary period; it does not differ from acute hepatitis of other etiology.

Syphilitic hepatitis is one of the forms of viscerosyphilis, in which the damage of internal organon, including liver, is observed.

Distinguish early and late liver damage in visceral syphilis. For early syphilitic hepatitis is characterized by changes in liver function indicators, violations of prothrombin and protein formation, less often - pigmentary function.

There are four forms of late syphilitic hepatitis: chronic epithelial, chronic interstitial, limited gummy and miliary hummus. For all forms characterized by a prolonged course of the process with a gradual development of sclerohumous changes leading to cirrhosis and deformation of the liver.

Chronic epithelial hepatitis occurs in the tertiary period of syphilis, when the phenomenon of hyperergic reactivity increases. In the tertiary period of syphilis, when the phenomena of hyperergic reactivity increase, secondary or spontaneous chronic epithelial hepatitis occurs.

Chronic syphilitic interstitial hepatitis develops as a result of diffuse-proliferative lesion of cells of interstitial tissue. As well as epithelial hepatitis, it can be formed even in the secondary period as a result of the direct penetration of pale treponem.

Miliary gammon hepatitis is characterized by the formation of nodular infiltrates. Hypertrophy of the liver with gummous hepatitis is characterized by unevenness, tuberosity, lobulation. Miliary gums are small in size, located around the vessels and less affecting the hepatic tissue.

Limited gummy hepatitis is characterized by the formation of large nodes with the involvement of secretory and interstitial areas. A zone of perifocal nonspecific inflammation is formed around the hum. At the final stages, marked sclerohumous atrophic, deforming scars are observed.

In the tertiary period of syphilis, gummous liver damage occurs most often, sometimes several decades after infection. The pathological process is the result of the introduction into the liver of pale spirochaetes that get into this organ by hematogenous way. Morphological changes are reduced to the formation in the liver of hums of different sizes, located in the peripheral parts of the liver (upper or lower surface of the liver, anterior margin). Located on the lower surface of the liver near its gates, gums can be a cause of blood supply disorders in the body and bile secretion. Histologically, gamma 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 parts of the gum are often necrotic, disintegrate and become inflamed, and a scar tissue forms at the site of the decay. Humming changes in the peripheral parts of the liver lead to the appearance of peri-hepatitis. The outcome of gummis hepatitis becomes syphilitic lobular liver,

[14], [15],

Diagnosis of syphilitic hepatitis

The diagnosis is made on the basis of anamnestic data on the disease of syphilis and the use in the past of specific antisyphilitic therapy of clinical manifestations; detection of a positive Wasserman reaction. However, the negative reaction of Wasserman does not exclude syphilitic hepatitis. The decisive importance is given to the data of the reaction of immunofluorescence, the reaction of immobilization of pale treponemes, as well as ELISA, RIGA, micro-precipitation reaction and the results of trial treatment.

When diagnosing syphilis of the liver, differential diagnostics with stomach or liver cancer, chronic hepatitis of other etiology, malaria with portal cirrhosis of the liver is necessary.

The prognosis of the disease depends on the stage and prevalence of the process. With a small number of gumms, the prognosis is favorable, since gums can undergo the resorption and scarring under the influence of specific therapy. With multiple and large gums, the outcome is uncertain. With severe gummy 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. Festering gums can serve as a source of purulent diseases of other organs (sub-diaphragmatic abscess, purulent purulent peritonitis).

[16], [17], [18], [19], [20],

Treatment of syphilitic hepatitis

Conduct course antisyphilitic treatment with iodine, mercury, benzylpenicillin, inside muscle injections of biyohinola 1-2 ml every other day (for a course of 20-30 ml). The use of drugs salvarsana, which have a toxic effect on the liver, should be avoided.

Since the liver, damaged by syphilitic infection, is particularly sensitive to specific drugs, the question of antisyphilitic treatment is extremely difficult. The most favorable is the treatment of gummy lesions of the liver. The main means are iodine and mercury. Salvarsan should be used with great care. It is advisable to carry out in parallel with a specific therapy for insulin with glucose.

Adequate penicillin therapy for a long time leads to a decrease in lesions.

Prevention of syphilitic hepatitis

Prevention of syphilitic hepatitis is the prevention of sexually transmitted diseases and the correct treatment of syphilis.