Primary Biliary Cholangitis Diagnosed During Follow-Up of a Man with HIV Infection and Syphilis: A Case Report.
- 1Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
- 2Department of Pathology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
- 3Second Department of Liver Disease Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
Abstract
Background
In people living with HIV, syphilis may present atypically and can involve the liver, making the etiology of liver injury difficult to determine. Primary biliary cholangitis (PBC), an autoimmune cholestatic liver disease, has rarely been reported in patients with HIV infection.Case presentation
A 34-year-old man was admitted in November 2024 with newly diagnosed HIV infection. Laboratory testing showed a viral load of 666,642 copies/mL, a CD4⁺ T cell count of 99 cells/μL (CD4 percentage, 4.31%), and positive syphilis serology with a TRUST titer >1:256. He also had liver dysfunction and a right hepatic lesion. Initial liver biopsy suggested severe infection-related liver injury with bile duct damage. However, a syphilitic etiology remained presumptive. After antiretroviral therapy, anti-syphilitic treatment, and supportive care, liver enzymes normalized and the hepatic lesion regressed markedly. Antinuclear and antimitochondrial antibodies, both negative at baseline, became positive during follow-up. Repeat liver biopsy performed in August 2025, approximately nine months after the initial admission, confirmed PBC stage 1-2, ursodeoxycholic acid therapy was initiated after the diagnosis was established.Conclusion
In HIV-infected patients with active syphilis and liver dysfunction, abnormalities should not be attributed to infection alone. Syphilis-associated liver injury in this case remained presumptive. Recognition of PBC during immune recovery after ART suggests a possible association, not proof of causation by syphilis or immune reconstitution. Dynamic follow-up, autoantibody monitoring, and repeat liver biopsy when clinically indicated may help identify coexisting autoimmune liver disease.
Related
- Proteomic profiling of liver and plasma uncovers biomarkers and mechanisms in patients with primary biliary cholangitis
- Acquired Palmoplantar Keratoderma Revealing Primary Biliary Cholangitis: Therapeutic Response to Ursodeoxycholic Acid.
- Endothelin-1 and Anticardiolipin Antibodies in Primary Biliary Cholangitis Patients with Portal Hypertension: A Pilot Retrospective Study.
- Liver Stiffness, Patient-Reported Fatigue, and Pruritus in Primary Biliary Cholangitis and Primary Sclerosing Cholangitis: A Cross-Sectional Study
- Depressive Symptoms, Sleep Quality, and Anhedonia in Patients with Primary Biliary Cholangitis: A Cross-Sectional Study
BibTeX
@article{wang2026primary,
title = {{Primary Biliary Cholangitis Diagnosed During Follow-Up of a Man with HIV Infection and Syphilis: A Case Report.}},
author = {Fuchun Wang and Yuan Fang and Jiahao Ji and Jing Chang and Yanmin Liu and Tong Zhang and Meixin Ren},
journal = {Infection and drug resistance},
year = {2026},
month = oct,
doi = {10.2147/idr.s631588},
url = {https://europepmc.org/article/MED/42928855},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Primary Biliary Cholangitis Diagnosed During Follow-Up of a Man with HIV Infection and Syphilis: A Case Report.
AU - Fuchun Wang
AU - Yuan Fang
AU - Jiahao Ji
AU - Jing Chang
AU - Yanmin Liu
AU - Tong Zhang
AU - Meixin Ren
PY - 2026
DA - 2026/10/21
JO - Infection and drug resistance
DO - 10.2147/idr.s631588
UR - https://europepmc.org/article/MED/42928855
AB - Background In people living with HIV, syphilis may present atypically and can involve the liver, making the etiology of liver injury difficult to determine. Primary biliary cholangitis (PBC), an autoimmune cholestatic liver disease, has rarely been reported in patients with HIV infection.Case presentation A 34-year-old man was admitted in November 2024 with newly diagnosed HIV infection. Laboratory testing showed a viral load of 666,642 copies/mL, a CD4⁺ T cell count of 99 cells/μL (CD4 percentage, 4.31%), and positive syphilis serology with a TRUST titer >1:256. He also had liver dysfunction and a right hepatic lesion. Initial liver biopsy suggested severe infection-related liver injury with bile duct damage. However, a syphilitic etiology remained presumptive. After antiretroviral therapy, anti-syphilitic treatment, and supportive care, liver enzymes normalized and the hepatic lesion regressed markedly. Antinuclear and antimitochondrial antibodies, both negative at baseline, became positive during follow-up. Repeat liver biopsy performed in August 2025, approximately nine months after the initial admission, confirmed PBC stage 1-2, ursodeoxycholic acid therapy was initiated after the diagnosis was established.Conclusion In HIV-infected patients with active syphilis and liver dysfunction, abnormalities should not be attributed to infection alone. Syphilis-associated liver injury in this case remained presumptive. Recognition of PBC during immune recovery after ART suggests a possible association, not proof of causation by syphilis or immune reconstitution. Dynamic follow-up, autoantibody monitoring, and repeat liver biopsy when clinically indicated may help identify coexisting autoimmune liver disease.
SN - 1178-6973
ER -