Section snippets

Establishing the Diagnosis

The differential diagnosis for acute cholestatic liver enzyme elevation is broad and can generally be separated into intrahepatic and extrahepatic causes. Radiological imaging is typically used to exclude extrahepatic causes including choledocholithiasis, biliary and ampullary stricturing, and malignancy. In our patient’s case, computed tomography and subsequent ultrasound demonstrated no evidence of biliary obstruction or duct dilation. In the absence of extrahepatic causes, causes of

Review

Syphilitic hepatitis (SH) is a rare manifestation of secondary syphilis, caused by the bacterium Treponema pallidum. Rates of syphilis infection are on the rise in many developed countries.¹ Since 2011, the incidence of syphilis infections in Australia has quadrupled from 6–24 per 100,000.² It is more commonly seen in men who have sex with men (up to 80.6%), immunocompromised patients, and people who inject drugs.^1,3 SH is a rare entity, and this combined with the frequently asymptomatic early

Patient Outcome

The patient began a 15-day course of 10.8 g over 24 hours of intravenous benzylpenicillin via infusion. Four hours after the first dose of benzylpenicillin (completed as an inpatient), the patient reported sudden-onset fever, rigors, and reduced visual acuity: consistent with the Jarish-Herxheimer reaction (severe immunologic phenomenon during penicillin therapy) and was treated with a short course of oral prednisolone. He recovered well and was discharged home. The patient’s partner was tested

中文翻译：

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胆汁淤积性肝损伤的奇特案例

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建立诊断

急性胆汁淤积性肝酶升高的鉴别诊断范围很广，通常可分为肝内和肝外原因。放射影像学检查通常用于排除肝外原因，包括胆总管结石、胆道和壶腹狭窄以及恶性肿瘤。在我们患者的病例中，计算机断层扫描和随后的超声显示没有胆道梗阻或胆管扩张的证据。在没有肝外原因的情况下，原因

 回顾

梅毒性肝炎 （SH） 是二期梅毒的一种罕见表现，由梅毒螺旋体引起。在许多发达国家，梅毒感染率呈上升趋势。¹ 自 2011 年以来，澳大利亚的梅毒感染发病率从每 100,000 人 6-24 人翻了两番。² 它更常见于男男性行为者（高达 80.6%）、免疫功能低下的患者和注射吸毒者。¹³ SH 是一种罕见的实体，这与通常无症状的早期

 患者结局

患者开始 15 天疗程，在 24 小时内通过输注静脉注射苄基青霉素 10.8 g。首次服用苄基青霉素 （住院完成） 4 小时后，患者报告突然发热、寒战和视力下降：与 Jarish-Herxheimer 反应 （青霉素治疗期间的严重免疫现象） 一致，并接受短期口服泼尼松龙治疗。他恢复得很好，出院回家了。患者的伴侣接受了测试