Syphilis-related rapidly progressive glomerulonephritis: a case presentation

Nephrotic "full-house" glomerulonephritis successfully treated with antibiotics alone in secondary syphilis: a case report

A Japanese female in her twenties developed general edema with heavy proteinuria, and was referred to our hospital. She exhibited the common clinical manifestation of idiopathic nephrotic syndrome with massive proteinuria (20.37 g/day), hypoalbuminemia (1.8 g/dL), and hypercholesterolemia (300 mg/dL). Routine admission tests were positive results for both the rapid plasma reagin latex agglutination test for syphilis (RPR) and the Treponema pallidum particle agglutination assay (TPHA). As such, we made her a diagnosis of nephrotic syndrome due to secondary syphilis. Renal biopsy revealed "full-house" nephropathy. Following the commencement of penicillin treatment, she developed skin rash, indicating the Jarisch-Herxheimer reaction (JHR). Her nephrotic syndrome responded rapidly and she achieved complete remission with antibiotic therapy alone after 4 weeks. In light of the increasing incidence of syphilis in Japan, clinicians should consider syphilis as a reversible cause of nephrotic syndrome.

Cholestatic Hepatitis with Concomitant Nephrotic Syndrome due to Secondary Syphilis in a Young Man

Introduction

Syphilis, an ancient sexually transmitted disease, is recognized as a systemic infection disease manifesting with diverse symptoms and variations. Secondary syphilis characterized by systemic symptoms resulted from hematogenous and lymphatic dissemination of the infection, may include manifestations such as hepatitis and nephrotic syndrome. However, the simultaneous occurrence of hepatitis and nephrotic syndrome in secondary syphilis is rare.

Case Presentation

A young man presented with fatigue, abnormal liver function tests, and hyperbilirubinemia and had history of men who have sex with men (MSM). Serological tests confirmed the diagnosis of secondary syphilis, and kidney biopsy indicated membranous nephritis. After antibiotic treatment, the patient experienced resolution of proteinuria, and liver enzyme levels returned to normal.

Conclusion

Syphilis should be considered in the differential diagnosis of simultaneous liver and kidney dysfunction, particularly in patients engaging in high-risk sexual behavior. This case highlights the importance of considering syphilis in young patients with MSM and presenting with unexplained nephrotic syndrome and liver abnormalities.

Crescentic glomerulonephritis associated with syphilis: a case report and review of the literature

BACKGROUND

Crescentic glomerulonephritis with syphilis infection is rare, and the mechanism underlying the formation of glomerular capillary wall damage-induced crescent has not been elucidated.

CASE PRESENTATION

A 62-year-old Japanese male showed edema, eruption, and rapid deterioration of the renal function after an acute syphilis infection. A renal biopsy showed crescentic glomerulonephritis with C3 deposition in the glomerular capillary wall, and immunostaining for anti-Treponema pallidum antibody was weakly positive in some interstitium and one glomerulus. Electron microscopy revealed the presence of string-shaped structures in the glomerular capillary walls. After treatment with penicillin followed by prednisolone, the renal function and urinary abnormalities, including Treponema pallidum protein, disappeared.

CONCLUSIONS

Crescentic glomerulonephritis associated with syphilis showed a string-shaped deposition in the glomerular capillary and urinary Treponema pallidum protein excretion, and was effectively treated with penicillin and prednisolone.

Atypical Presentation of Tubulointerstitial Nephritis and Uveitis Syndrome, a Rare Disease

Purpose

To expand the current knowledge of tubulointerstitial nephritis and uveitis syndrome (TINU), which might assist other ophthalmologists in recognizing and treating patients with this rare disease.

Methods

A patient with atypical demographics and features was compared with previously described TINU cases. The case was analyzed in terms of how it compares with more "classic" cases, and the differences were identified.

Results

The diagnosis of TINU is ultimately clinical, although aided by previous studies. Thus, it might present challenges when patients do not have the typical demographics or presenting features of TINU.

Conclusions

Our patient showed features that deviated from classic TINU. Knowledge of the disease and a comprehensive view of the patient's medical state might help lead to accurate diagnosis and treatment.

Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. With the recent worldwide resurgence of syphilis, it is imperative to recognize various presentations of this great imitator. Renal syphilis is rare and most commonly present as nephrotic range proteinuria associated with pathological features of membranous glomerulonephritis. Rapidly progressive glomerulonephritis (RPGN) is a rare and atypical form of renal syphilis. A 50-year-old Ethiopian woman presented with periorbital swelling, hematuria, proteinuria, and rapidly progressive renal failure. Rapid plasma reagin and confirmatory Treponema pallidum hemagglutination (TPHA) tests were reactive. Treatment with a weekly Benzathine penicillin for 3 weeks resulted in a rapid return of renal function to baseline, with the increasing rate of new syphilis, clinicians should be mindful of the various renal manifestation of syphilis. This case highlights the significance of considering syphilis as a reversible cause in any patient presenting with a clinical feature suggestive of RPGN.