Skip to main content
  • Correspondence
  • Open access
  • Published:

Authors response to correspondence regarding paper entitled Syphilitic hepatitis: a case report and review of the literature

The Original Article was published on 12 November 2020

Abstract

In the correspondence from Abdurrahman et al., they raised three main concerns and critiques of our recently published article entitled “Syphilitic hepatitis: a case report and review of the literature”. First question pertains to the timing of dermatology opinion, second regarding the history of sexual exposure, and lastly regarding the treatment duration of syphilitic hepatitis. We thank the authors for their constructive comments and would like to answer these questions in detail.

Peer Review reports

We appreciate the detailed review and commentary on our manuscript [1] from Abdurrahman et al. [2]. The first concern is regarding the timing of dermatology consult and syphilitic rashes. The patient described in our manuscript had two dermatology consultation. The first consult was at the local hospital when the rashes were noticed, and the second consult at our referral hospital upon admission. At both consultation with dermatologist, the opinion was that the rashes were secondary to an allergic reaction. The complete clinical examination of the genitals, palms and soles but did not reveal any skin lesions. Syphilitic rashes are known to occur in around 80% of patients with syphilitic hepatitis [3], and often present as multiple non-pruritic, erythematous, nonconfluent maculopapular lesions generally concentrated in the trunk, palms and soles of the feet. We agree with the authors that if the correct diagnosis of syphilitic hepatitis could have been made earlier, the invasive liver biopsy could have been avoided. This is precisely the reason why we decided to report this particular case.

Second, Abdurrahman et al. noted that we did not describe the patient's sexual history in detail, we agree with him on this point. In fact, the patient denied a history of unsafe sexual activity upon admission, which we duly stated in the manuscript. Interestingly, even after the syphilis infection was confirmed, patient still denied any history of unsafe sexual activity. However, even in the absence of a clear high risk sexual history, the antibody positivity was still powerful evidence of the diagnosis of Syphilis infection.

The third question Abdurrahman et al. raised is about the duration of antibiotics administered to patient for syphilitic hepatitis. The recommended duration of antibiotic administration is 2–4 weeks [4]. The reported patient was discharged after the first dose of penicillin injection from our hospital. At the second follow-up visit, patient informed us that he has received a 2-month penicillin injection at a local clinic. We too concure with Abdurrahman et al. that the treatment duration of 2 months was too long and is problematic at multiple levels, however we recorded and reported the case-report as matter of fact. Prolonged duration of treatment however would not change the diagnosis of syphilitic hepatitis.

In conclusion, although there are some deficits and missing information in our case report, the diagnosis of syphilis is quite clear. This case highlights an atypical presentation of syphilitic hepatitis and and we hope that readers would get better insight into this rare disease.

Availability of data and materials

Not applicable.

References

  1. Huang J, Lin S, Wang M, Wan B, Zhu Y. Syphilitic hepatitis: a case report and review of the literature. BMC Gastroenterol. 2019;19(1):191.

    Article  Google Scholar 

  2. Kaya A, Kaya SY. Management of syphilitic hepatitis. BMC Gastroenterol. 2020. https://0-doi-org.brum.beds.ac.uk/10.1186/s12876-020-01496-5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Huang J, Lin S, Wan B, Zhu Y. A systematic literature review of syphilitic hepatitis in adults. J Clin Transl Hepatol. 2018;6(3):306–9.

    Article  Google Scholar 

  4. Ghanem K, Ram S, Rice P. The modern epidemic of syphilis. N Engl J Med. 2020;382(9):845–54.

    Article  Google Scholar 

Download references

Acknowledgements

We are very grateful to Abdurrahman et al. for the detailed evaluation of our article.

Funding

This work received no dedicated research funding.

Author information

Authors and Affiliations

Authors

Contributions

JH and SL wrote the primary draft. YZ, BW and MW made critical comments. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Su Lin.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

All authors have no conflicts of interests to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, J., Wan, B., Wang, M. et al. Authors response to correspondence regarding paper entitled Syphilitic hepatitis: a case report and review of the literature. BMC Gastroenterol 20, 385 (2020). https://0-doi-org.brum.beds.ac.uk/10.1186/s12876-020-01497-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/s12876-020-01497-4

Keywords