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Canadian Journal of Gastroenterology
Volume 1, Issue 1, Pages 37-40

Granulomatous Hepatitis in Association with Fever and a Palmar Rash

Desmond J Leddin and James A Barrowman

Faculty of Medicine, Memorial University of Newfoundland, St John’s, Newfoundland A1B 3V6, Canada

Received 10 May 1987; Accepted 4 June 1987

Copyright © 1987 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Secondary syphilis may present without the classical features of the disease and should be considered in patients acutely ill with abnormal liver function tests and a nonspecific pattern on liver biopsy. Secondary syphilis may present in association with granulomatous hepatitis and serological testing should be performed if the etiology of the hepatic granulomas is unclear. While the finding of a disproportionate elevation of alkaline phosphatase relative to serum bilirubin may be a useful pointer towards the diagnosis this pattern is not specific and not consistently observed. The definitive answer to the question of whether syphilitic hepatitis exists awaits the development of comprehensive rests to exclude viral pathogens.