Clinical Manifestations of Congenital Syphilitic Hepatitis

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Abstract
To study the clinical course and biochemical features of congenital syphilitic hepatitis, the records of all 22 pediatric patients with a positive maternal, cord blood, or serum VDRL [venereal disease research laboratory] were reviewed. Of the 7 infants identified with symptomatic congenital syphilis, 5 had clinical and biochemical evidence of liver dysfunction. All 5 were jaundiced (peak bilirubin ranged from 8.4-29.8 mg/dl, in each case > 40% conjugated). Peak transaminase elevation ranged from 7-150 times normal. Serum glutamic-oxaloacetic transaminase exceeded serum glutamic-pyruvic transaminase in each infant, the difference ranging to 7400 U. The onset of illness did not occur until after treatment was initiated in 2 of 5 cases. Liver dysfunction increased with treatment in all 4 infants with serial enzyme determinations. Liver dysfunction also persisted for more than 6 wk after adequate treatment in 2 cases. Liver biopsy 5 wk after treatment in another infant showed giant cell hepatitis. Treatment apparently can potentiate liver dysfunction in congenital syphilis and viable treponemes are not necessarily essential in the pathogenesis of the hepatitis.

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