Jaundiced after a partyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3441 (Published 29 June 2011) Cite this as: BMJ 2011;342:d3441
All rapid responses
Dear Dr Pratsides and Colleagues,
In response to: Endgames- Jaundiced after a party
Luke A E Pratsides, Jean Nehme, Mark R Thursz, and Robert D Goldin.
Whilst the aetiology of the clinical hepatitis was correctly
identified by the authors as drug-induced hepatitis, we feel it is
important for your readership to be aware of three other potential
differential diagnoses in men who have sex with men (MSM) presenting with
an acute transaminitis.
Firstly, there is an ongoing epidemic of acute hepatitis C amongst
MSM currently affecting the UK (particularly Brighton and London) and
other parts of the developed world (Richardson D et al. Sexual
transmission of hepatitis C in MSM: may not be entirely confined to those
with HIV infection? JID 2008;15:1213). This may well not be detected by
routine serology during the acute phase as antibody seroconversion may
take weeks to months (Thomson EC et al. Delayed anti-HCV antibody response
in HIV-positive men acutely infected with HCV AIDS. 23:89-93.) and so a
hepatitis C PCR would be recommended in this scenario.
Secondly, there have been international outbreaks of syphilis
reported in MSM, including the UK (Jebbari H et al. Variations in the
epidemiology of primary, secondary and early latent syphilis, England and
Wales: 1999 to 2008 STI 2011;87:181). Syphilis, particularly in the
secondary stage, should definitely be considered as a differential in an
MSM with abnormal liver function tests.
Thirdly, testing for HIV infection should have been recommended.
Whilst HIV itself only rarely produces abnormal LFTs, it is more common in
those individuals with other causes for abnormal liver function (including
hepatitis C and syphilis). Furthermore, current NICE and BHIVA (British
HIV association) testing guidelines would recommend that the opportunity
to offer HIV testing should be taken in any MSM attending healthcare
Competing interests: No competing interests