[Hypersensitive reaction to abacavir or syphilitic hepatitis?]

Author(s): Dumouchel-Champagne H, Bouhour D, Ferry T, Durupt F, Granier P

Affiliation(s): Service de medecine interne et des maladies infectieuses, Hopital de Fleyriat, Bourg-en-Bresse.

Publication date & source: 2003-10-11, Presse Med., 32(33):1557-8.

Publication type: Case Reports

INTRODUCTION: Syphilis remains a current infection in France, with an increase in cases associated with the increase in sexual practices at risk. OBSERVATION: An HIV-seropositive homosexual male presented with a perturbed hepatic profile and roseola-like exanthema 15 days after starting treatment with Trizivir. Because of the combination of hepatitis and cutaneous eruption evoking hypersensitivity to abacavir, treatment was suspended, but no improvement was noted. The diagnosis of syphilitic hepatitis associated with roseola was made following a sero-conversion and improvement was obtained with benzathine-penicillin and the re-introduction of Trizivir without further problem. COMMENTS: This case report underlines the possibility of discovering syphilis when confronted with cholestatic and cytolytic hepatitis that regresses with penicillin and is isolated or associated with evocative cutaneous signs.