Key words: Early Syphilis, Liver involvement, Drug induced hepatitis Table 1 Laboratory findings
305 昭 和54年6月20日 Fig. (正 常 値51 1521U),α-GTP851Uと め ら れ,ChlEは9001U(正 と 低 値 で あ つ た.総 二昇 が 認 蛋 白 ぱ6.3g/dlと 原(RPHA法),抗 と も に 陰 性,α-フ マ ン 反 応(北 Clinical や や低 い が 増 加 して 体(PHA法) 倍 陽 性 で あ つ た.ツ was presented た.胆 道 造 影 お よ び 腎 孟 尿 管 造 影 も異 常 を 認 め な 入 院 後 経 過(Fig.1)入 ッセ ル で 強 陽 性,T.P.H.A.160 ベ ル ク リ ン反 応 は 陰 性 で あ つ 院 前39 前 後 み ら れ た 発 熱 も入 院 と 同 時 に 解 熱 剤 も使 用 せ ず 平 熱 と な つ た.一 ェ ト プ ロ テ イ ン 陰 性,ワ 研 法)20倍 course か つ た. 常 値2,375-47501U) γlグ ロ ブ リ ン と く にIgMは269mg/dlと い た.HB抗 1 方 発 熱 の 精 査 目 的 で 山液,尿,十 の培 養,ツ 二指腸液 ベ ル ク リ ン 反 応,胆 道 お よび 腎孟 尿管 造 影 等 の 検 査 を 施 行 した が,す べ て 正 常範 囲 内 も し く は,異 常 を 認 め な か つ た.し く にGOTと か し血 清酵 素 と アル カ リフ ォス フ ァ タ ーゼ は 入 院 後 さ ら に 上昇 傾 向 を 示 した た め 肝 生 検 を 施 行 し た と こ ろFig2とFig3に Fig. 2 raund The portal cells tract including was seen infiltration polymorphonuclear leukoc- ytes. In the lobulus liver several scattered focie degeneration and necrosis also were observed. (H-E stain. 100 X) 示 す 様 な 所 見 を 得 た 組 織 Fig. 3 cells Many were scatterred obsereve foci in this area. necrosis liver
1) Syphilis: Recommended treatment schedules, 1976. Ann. Intern. Med., 85: 94-96, 1976. 2) Bockus, H. L.: Gastroenterology, 3rd ed., W. B. Saunders., Philadelphia 1976, p.509. 3) Hahn, R. D.: Syphilis the liver. Amer. J. Syh., 27: 529-562, 1943. 4) Baker, A. L., et al.: Liver disease associated with early syphilis. New. Eng. J. Med., 284: 1422-1423, 1971. 5) Sobel, H.J. and Wolf, E. H.: Liver involve- in early syphilis. Arch Path., 93: 565- ment 568, 1972. 6) Feher, J.: Early syphilitic hepatitis. Lancet., 1: 869-899, 1975. 7) Birgitte Wanscher and Jens Thormann: Leveraffection ved tidlig syphilis. Ugeskr. Laeg., 139: 1296-1297, 1977. 8) Goodmann, S. L. and Gilman, A.: The Phar- Basis Therapeutics macological 5th ed. p. 330, 1975, Macmillan.
Liver Involvement Early Syphilis. A Report Case Hiromichi SUZUKI, Fuyuhiko HIGASHI, Shoichiro IRIMAJIRI, Ippei FUJIMORI and *Junya FUKUDA Department Internal Medicine *Department Pathology Kawasaki Municipal Hospital A 38-year-old woman was admitted on 26th August, because fever unknown origin. enjoyed good health until August 16th, 1977 when she suddenly had high fever accompanied by chills. On 20th August, she called on a physician in the outpatient department KawasakiMunicipal Aspirin and antibiotics were given and then fever disappeared. Her past history disclosed no problems. on his penis after travelling abroad. the inguinales and axillas and hepatomegaly. She Hospital. On 23rd, high feverredeveloped. However, her husband confessed he noticed initial induration Physical examination revealed swelling surface lymphnodes in Laboratory data showed GOT 49 IU, GPT 26 IU, alkalinephosphatase 525 IU, a-gpt 85 IU, HBAg nagative, STS positive and IgM 269 mg/dl. Liver biopsy was perfomed and it showed that the portal duct was infiltrated by round cells with polymorphonuclear leukocytes and in the lobules liver several scattered foci degeration and necrosis were observed. The pathological changes stated above was compatible with the liver involvement early syphilis. The elevation serum transaminase gradually went down into the normal range with the treatment erythromycin.