Syphilitic Pneumonitis in an HIV-Infected Patient

Pneumonitis and symptomatic hepatitis are very rare complications of syphilis. Symptomatic hepatitis and subclinical reticulonodular pulmonary infiltrates were observed when an HIV-infected patient presented with secondary syphilis. The Jarisch-Herxheimer reaction included a flare of hepatitis symptoms, resembling cholangitis. In a patient with syphilis, it may be appropriate to delay an aggressive evaluation for suspected pneumonitis or cholangitis pending the outcome of specific antitreponemal therapy.