{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:36:43Z","timestamp":1793507803676,"version":"4.5.0"},"reference-count":16,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,1,26]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>A 32-year-old man was referred to our clinic for evaluation of abnormal liver function tests and concurrent proteinuria. Physical examination revealed a maculopapular rash, involving the trunk and palms, and multiple \u2018moth-eaten\u2019 patches of alopecia. After a prolonged diagnostic work-up a hepatitis with concomitant nephrotic syndrome due to secondary syphilis was diagnosed. Treatment with benzylpenicillin led to complete clinical recovery. Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.<\/jats:p>\n               <jats:p>Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.<\/jats:p>","DOI":"10.1136\/bcr-2019-232615","type":"journal-article","created":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T04:35:14Z","timestamp":1580963714000},"page":"e232615","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Cholestatic hepatitis with concomitant nephrotic syndrome due to late syphilis in an immunocompetent 32-year-old man"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6218-2239","authenticated-orcid":false,"given":"Philipp","family":"Kasper","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Nierhoff","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Goeser","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University of Cologne, Cologne, North Rhine Westphalia, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,2,5]]},"reference":[{"key":"2025082711211120000_13.2.e232615.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32411-4"},{"key":"2025082711211120000_13.2.e232615.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.29046\/TMF.011.1.015","article-title":"The \u201cgreat imitator\u201d presents with abnormal liver enzymes","volume":"11","author":"Suzuki","year":"2009","journal-title":"TMF"},{"key":"2025082711211120000_13.2.e232615.3","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s10620-012-2322-1","article-title":"A great masquerader: acute syphilitic hepatitis","volume":"58","author":"Lee","year":"2013","journal-title":"Dig Dis Sci"},{"key":"2025082711211120000_13.2.e232615.4","first-page":"1","article-title":"Syphilis and congenital syphilis in Europe - A review of epidemiological trends (2007-2018) and options for response.European Centre for Disease Prevention and Control","volume":"9","author":"Vazquez","year":"2019","journal-title":". ECDC Reports"},{"key":"2025082711211120000_13.2.e232615.5","first-page":"bcr2012008279","article-title":"Syphilis: a reversible cause of nephrotic syndrome","volume":"2013","author":"Handoko","year":"2013","journal-title":"Case Reports"},{"key":"2025082711211120000_13.2.e232615.6","doi-asserted-by":"crossref","DOI":"10.1097\/OLQ.0000000000000850","article-title":"Syphilitic alopecia","volume":"45","author":"Sebaratnam","year":"2018","journal-title":"Sex Transm Dis"},{"key":"2025082711211120000_13.2.e232615.7","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1053\/j.gastro.2019.01.007","article-title":"An uncommon cause of fever and altered levels of liver enzymes","volume":"156","author":"Hashash","year":"2019","journal-title":"Gastroenterology"},{"key":"2025082711211120000_13.2.e232615.8","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1002\/hep.28974","article-title":"Emerging secondary syphilis presenting as syphilitic hepatitis","volume":"65","author":"Rubio-Tapia","year":"2017","journal-title":"Hepatology"},{"key":"2025082711211120000_13.2.e232615.9","doi-asserted-by":"crossref","first-page":"550","DOI":"10.14740\/jocmr2595w","article-title":"Secondary syphilis with hepatitis and nephrotic syndrome: a rare concurrence","volume":"8","author":"Makker","year":"2016","journal-title":"J Clin Med Res"},{"key":"2025082711211120000_13.2.e232615.10","doi-asserted-by":"crossref","first-page":"813","DOI":"10.4321\/S1130-01082009001100011","article-title":"Syphilitic hepatitis: case report","volume":"101","author":"Albandea-Moreno","year":"2009","journal-title":"Rev. esp. enferm. dig."},{"key":"2025082711211120000_13.2.e232615.11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/8645068","article-title":"Liver cholestasis secondary to syphilis in an immunocompetent patient","volume":"2018","author":"Hussain","year":"2018","journal-title":"Case Reports Hepatol"},{"key":"2025082711211120000_13.2.e232615.12","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1681\/ASN.V371351","article-title":"Secondary syphilis and the nephrotic syndrome","volume":"3","author":"Hunte","year":"1993","journal-title":"J Am Soc Nephrol"},{"key":"2025082711211120000_13.2.e232615.13","doi-asserted-by":"publisher","DOI":"10.5414\/CNP70532"},{"key":"2025082711211120000_13.2.e232615.14","doi-asserted-by":"publisher","DOI":"10.1093\/ndtplus\/sfq194"},{"key":"2025082711211120000_13.2.e232615.15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s13730-015-0173-2","article-title":"Simultaneous nephrotic syndrome and hepatitis in secondary syphilis: case report and review of the literature","volume":"4","author":"Ishiwatari","year":"2015","journal-title":"CEN Case Rep"},{"key":"2025082711211120000_13.2.e232615.16","doi-asserted-by":"publisher","DOI":"10.1007\/s11901-010-0042-6"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232615","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:21:18Z","timestamp":1756318878000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2,5]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/bcr-2019-232615"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232615","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}