Granulomatous Hepatitis in Association with Fever and a Palmar Rash

Secondary syphilis may present without the classical features of thedisease and should be considered in patients acutely ill with abnormal liver functiontests and a nonspecific pattern on liver biopsy. Secondary syphilis may present inassociation with granulomatous hepatitis and serological testing should be performedif the etiology of the hepatic granulomas is unclear. While the finding of a disproportionateelevation of alkaline phosphatase relative to serum bilirubin may be a usefulpointer towards the diagnosis this pattern is not specific and not consistently observed.The definitive answer to the question of whether syphilitic hepatitis exists awaits thedevelopment of comprehensive rests to exclude viral pathogens