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Despite adequate diagnosis and treatment, the patient developed fulminant hepatitis and brain death. This atypical presentation emphasizes the importance of high clinical suspicion in recognizing syphilis as an etiology for unexplained acute hepatitis, allowing early diagnosis and treatment and possibly avoiding severe complications such as fulminant hepatic failure.<\/jats:p>","DOI":"10.1177\/0956462418785257","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T09:59:44Z","timestamp":1530871184000},"page":"1348-1350","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Fulminant hepatitis in a patient with secondary syphilis"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-508X","authenticated-orcid":false,"given":"Ana Beatriz","family":"Affonso da Costa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hospital de Cl\u00ednicas \u2013 UFPR, Curitiba, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruna","family":"Fornazari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital de Cl\u00ednicas \u2013 UFPR, Curitiba, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Perin Maia","family":"da Silva","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital de Cl\u00ednicas \u2013 UFPR, Curitiba, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gibran A","family":"Frandoloso","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital de Cl\u00ednicas \u2013 UFPR, Curitiba, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni L","family":"Breda","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Hospital de Cl\u00ednicas \u2013 UFPR, Curitiba, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,7,6]]},"reference":[{"issue":"36","key":"bibr1-0956462418785257","volume-title":"Syphilis epidemiological report 2017","volume":"48","author":"Health Surveillance Department","year":"2017"},{"key":"bibr2-0956462418785257","volume-title":"Sexually transmitted disease surveillance 2016","author":"Centers for Disease Control and Prevention","year":"2017"},{"key":"bibr3-0956462418785257","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.eimc.2012.12.014","volume":"31","author":"Gonzalez LC","year":"2013","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"bibr4-0956462418785257","first-page":"529","volume":"27","author":"Hahn RD.","year":"1943","journal-title":"Am J Syph Gonorrhea Vener Dis"},{"key":"bibr5-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-200205000-00022"},{"key":"bibr6-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.mi.35.100181.000333"},{"key":"bibr7-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1007\/BF01297236"},{"key":"bibr8-0956462418785257","first-page":"896e9","volume":"2","author":"Feher J","year":"1975","journal-title":"Lancet"},{"key":"bibr9-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-198209000-00031"},{"key":"bibr10-0956462418785257","first-page":"451","volume":"103","author":"Brooks SE","year":"1979","journal-title":"Arch Pathol Lab Med"},{"key":"bibr11-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2018.02.017"},{"key":"bibr12-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1023\/B:DDAS.0000042237.40205.c6"},{"key":"bibr13-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2006.07.005"},{"key":"bibr14-0956462418785257","doi-asserted-by":"publisher","DOI":"10.1007\/BF02010324"},{"key":"bibr15-0956462418785257","doi-asserted-by":"publisher","DOI":"10.3928\/0090-4481-20040101-06"}],"container-title":["International Journal of STD &amp; 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