Membranous Glomerulonephritis as an Uncommon Presentation of Secondary Syphilis: A Reminder on Therapeutic Decision-Making in Clinical Practice

Abstract

Membranous glomerulonephritis is one of the common causes of nephrotic syndrome in the adult population. It is idiopathic in the majority of patients, but the secondary forms can be seen in the setting of autoimmune disease, cancer, infection, and following exposure to certain medications. However, subclinical syphilis-related membranous nephropathy remains a particularly rare clinicopathologic entity in modern times. In this article, we chronicle an interesting case of latent syphilis masquerading as membranous glomerulonephritis, which resolved with benzathine penicillin without requiring immunosuppressive treatment. We further supplement this paper with a concise review of the relevant literature that delineates the utility of appropriate antibiotic therapy in the management of luetic membranous nephropathy. Clinicians should remain cognizant of secondary syphilis while evaluating patients for possible glomerulonephritis or those presenting with proteinuria. Additionally, patients with hepatitis B, hepatitis C, and human immunodeficiency virus infections are not infrequently coinfected with Treponema pallidum. Therefore, a high index of suspicion for systemic manifestations of syphilis such as nephrotic syndrome is warranted in the setting of a coinfection. Prompt diagnosis and treatment of syphilis may result in resolution of proteinuria, without the need for standard immunosuppressive therapy commonly used in clinical practice.

Syphilis as the great mimicker: A case of full‐house pattern membranous nephropathy

“…Syphilis membranous nephropathy is typically associated with IgG and C3 IHC staining. In all reported cases of syphilis associated glomerulonephritis there was recovery of renal function and resolution of nephrotic syndrome following treatment 5 . The rapidity of nephrotic syndrome resolution after antibiotics, and the absence of any clinical or serological evidence of lupus, as well as the presence of a mild transaminitis, supported the diagnosis of secondary syphilis.…”

“…In all reported cases of syphilis associated glomerulonephritis there was recovery of renal function and resolution of nephrotic syndrome following treatment. 5 The rapidity of nephrotic syndrome resolution after antibiotics, and the absence of any clinical or serological evidence of lupus, as well as the presence of a mild transaminitis, supported the diagnosis of secondary syphilis. TDF-containing PrEP has been associated with nephrotoxicity, in particular proximal tubular dysfunction including Fanconi syndrome.…”

Syphilis and nephrotic syndrome: A case report and literature review

“…In addition, in this case, renal biopsy was not performed because proteinuria was treated with antibiotics only. Generally, in most cases of nephrotic syndrome caused by syphilis, renal pathology shows a form of membranous nephropathy [3] , [4] . Secondary nephrotic syndrome due to syphilis is a well-known but rare complication, and the incidence of nephrotic syndrome in early syphilis was reported to be 0.28 % in an older study in 1935 [9] .…”

Ocular manifestations and full house membranous nephropathy as a rare presentation of secondary syphilis

“…Unfortunately, however, the rate of infection has been steadily increasing over the past twenty years with approximately 55,400 people newly infected with syphilis in the US each year [2] . Syphilis is most commonly present in patients co-infected with human immunodeficiency virus and should be high on the differential when patients present with risk factors including engaging in unprotected sexual intercourse, oral sex, having multiple partners, or in populations such as men who have sex with men [3] . In the case of our patient, our suspicion for a sexually transmitted infection was increased secondary to his unprotected sexual encounter several months prior.…”