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A 48-year-old actively homosexual man who had undergone liver transplantation for cirrhosis secondary to hepatitis B infection six years previously presented with a syndrome of diffuse pain, cholestasis, and low-grade fever. The development of thrombocytopenia and persistent hypoprothrombinemia precluded liver biopsy. Subsequently, a skin eruption and VDRL result of 1:128 indicated that most of the findings could be explained by a diagnosis of secondary syphilis with luetic hepatitis and periostitis. This impression was confirmed by a complete response to penicillin therapy. The relation of thrombocytopenia to lues in this case remains uncertain.
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