A Case of HIV-associated Early Syphilis with Multiple Hepatic Mass Lesions that was Successfully Treated with Oral Amoxicillin Therapy

Background: Syphilis is a systemic infection caused by *Treponema pallidum* with a variety of clinical manifestations. Hepatic involvement occurs in approximately 2.7%-10% of cases of syphilis and may present as acute hepatitis or inflammatory mass lesions mimicking malignancy. Case: A 45-year-old HIV-positive man presented with a history of fever and fatigue. Laboratory tests revealed elevated RPR (328 R.U.) and TPHA (40,960×) titers without elevation of the liver enzyme levels. The initial CT was unremarkable, but a follow-up CT one week later revealed multiple areas of low attenuation in the liver. The patient was initiated on treatment with oral amoxicillin at 3g/day. The fever resolved within four days, and serial imaging showed progressive regression of the hepatic lesions, with complete resolution noted on day 34 after the start of treatment. Conclusion: The rapid onset and rapid resolution of the lesions following initiation of antibiotic therapy support the diagnosis of syphilitic hepatitis. Early recognition and appropriate treatment can prevent progression to more severe hepatic complications.