Multiple liver metastases of unknown origin: A case report

Table 1 Characteristics of previously reported cases of hepatic nodules caused by syphilis

Ref.	Country	Gender	Age	Primary symptoms	Radiologic or ultrasonic findings	Stage of syphilis	HIV infection	Treatment	Outcome
Maincent et al[5], 1997	France	Female	56	Right upper quadrant abdominal pain	Several low-density nodules with no contrast uptake	III	No	Penicillin G (daily for five days and weekly for six weeks)	The abdominal pain subsided, and the liver nodules disappeared
Peeters et al[13], 2005	/	Female	47	Vision problems, pain in the right hypochondrium, one enlarged submandibular lymph node	Two hepatic lesions	III	No	Doxycyclin	The sedimentation rate and liver tests normalized, and the hepatic lesions disappeared. However, vision problems remained
Mahto et al[6], 2006	United Kingdom	Male	44	Fever, severe persistent upper abdominal pain, weight loss, and a desquamating rash on the palms and soles	Mildly enlarged liver with multiple ill-defined hypoechoic lesions	II	Yes	Doxycycline twice daily for a month	Repeat CT at one month showed that the largest mass decreased in size, and at two months, there was near-complete resolution of the liver masses
Shim[7], 2010	South Korea	Female	65	Intermittent abdominal pain and distension	Ascites and two hepatic nodules with peripheral enhancement	III	No	In the beginning, platinumbased combination chemotherapy for six months; after recurrence, penicillin was used	Complete response after six cycles of chemotherapy but recurrence after nine months; liver nodules disappeared followed by penicillin application
Hagen et al[3], 2014	United States	Male	51	Follow-up with liver lesions during chemotherapy for Burkitt lymphoma	Two liver lesions on PET	I	Yes	Penicillin G for 2-3 weeks	Resolution of liver test abnormalities and 50% reduction of the liver masses size
		Male	53	Right upper quadrant abdominal pain and weight loss	Multiple enhancing lesions in the liver and spleen, up to 5.7 cm	I	Yes		Liver tests resolved, but follow-up imaging was not performed
		Male	47	Fatigue, left lower chest wall pain, fever, chills, intermittent diarrhea, and nausea	Over 50 enhancing lesions in the liver, the largest measuring 2.6 cm	I	Yes		The liver test abnormalities resolved, and virtually complete resolution of the hepatic lesions was achieved
Gaslightwala et al[11], 2014	United States	Male	59	Persistent fevers, chills, night sweats, and weight loss	Multiple intensely hypermetabolic hepatic lesions on PET/CT	III	No	Penicillin G	None
Desilets et al[14], 2019	Canada	Male	54	General deterioration, posterior rib pain, progressive weight loss	PET-scan showed multiple hypermetabolic liver nodules	II	Yes	Penicillin G	Complete interval resolution of hypermetabolic osteomedullary and liver lesions
Al Dallal et al[15], 2021	United States	Female	36	Unresponsive with convulsions of all extremities and fever	Multiple hypoenhancing lesions	III	No	Penicillin G for only four days due to patient refusal	Liver function improved, but follow-up imaging was not performed
Smith et al[16], 2022	Australia	Male	39	Right upper quadrant and several weeks of fluctuating tenesmus and diarrhea	Short segmental, irregular rectal wall thickening, bilateral mesorectal lymphadenopathy, and multiple hypoattenuating liver lesions	III	Yes	Penicillin G	Significant reduction in the size of a dominant lesion in the right anterior liver section, with no other appreciable lesions
Otsuka et al[8], 2023	Japan	Female	50	Low-grade fever and nausea	Three nodules in the S3, S4, and S5 of the liver with round ring enhancement at the portal phase	III	No	Sulbactam sodium and ampicillin sodium	Marked downsizing of liver nodules

HIV: Human immunodeficiency virus; CT: Computed tomography; PET: Positron emission tomography.