Lymphadenopathy is frequently generalized in secondary syphilis. Symptomatic periosteal involvement was common in the pre-penicillin era but is rare today, although technetium bone scanning frequently reveals lesions. About 20% of cases have elevated liver enzymes, though symptomatic hepatitis is rare. Deposition of immune complexes may cause arthritis, anterior uveitis, iritis, and glomerulonephritis. In the absence of HIV disease, upwards of 40% of patients may have abnormal cerebrospinal fluid, although only a few percent will have meningismus.