Nephrotic syndrome and hepatitis due to acquired syphilis: an uncommon presentation of a re-emerging disease

Canney, Mark; Liu, Eunice; Vonthethoff, Leon; Weatherall, Chris; Ong, Sim‐Heng

doi:10.1093/ndtplus/sfq194

Cited by 5 publications

(4 citation statements)

References 13 publications

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“… 17 , 18 Notably, patients with syphilitic nephropathy may also concurrently develop acute hepatitis. 19 - 23 Given the possibility of deranged hepatic function, liver function testing is important. Furthermore, a detailed clinical history, especially information regarding safer sex practices, is pertinent in these patients.…”

Section: Discussionmentioning

confidence: 99%

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

Inayat

Almas

Bokhari

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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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.

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Section: Discussionmentioning

confidence: 99%

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

Inayat

Almas

Bokhari

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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show abstract

“…Despite the liver and kidney can be affected due to secondary syphilis, a concomitant involvement of both organs is an extremely rare finding and has been reported only a few times before 10 14–16. Differential diagnosis of concomitant syphilis hepatitis and nephrotic syndrome include hepatitis B infection, drug-induced, autoimmune and vascular etiologies 5 13–16…”

Section: Discussionmentioning

confidence: 99%

Cholestatic hepatitis with concomitant nephrotic syndrome due to late syphilis in an immunocompetent 32-year-old man

et al. 2020

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A 32-year-old man was referred to our clinic for evaluation of abnormal liver function tests and concurrent proteinuria. Physical examination revealed a maculopapular rash, involving the trunk and palms, and multiple ‘moth-eaten’ patches of alopecia. After a prolonged diagnostic work-up a hepatitis with concomitant nephrotic syndrome due to secondary syphilis was diagnosed. Treatment with benzylpenicillin led to complete clinical recovery. Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.Syphilis is a re-emerging infectious disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behaviour.

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“…In the case, we report the patient had not carried out any immunosuppressive treatment and proteinuria remited before infection treatment. This spontaneous remission is characteristic of secondary syphilis manifestations, 7 although the pathophysiological explanation to this finding was not found.…”

mentioning

confidence: 86%

“…Hohenstein et al reported that a homozygous c.917A>T polymorphism in the EVER2 may contribute to the differences in occurrence of EV in HIV-positive patients. 7 Although still very much speculative, it was possible that DOCK8 deficiency together with the described polymorphisms in EVER1 gene may be added to those susceptible factors…”

Section: Pustular Erythema Multiforme Major Associated With Atypical mentioning

confidence: 99%

Pustular erythema multiforme major associated with atypical pneumonia

Wolf

Ständer

Well

et al. 2017

Acad Dermatol Venereol

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Nephrotic syndrome and hepatitis due to acquired syphilis: an uncommon presentation of a re-emerging disease

Cited by 5 publications

References 13 publications

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

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

Cholestatic hepatitis with concomitant nephrotic syndrome due to late syphilis in an immunocompetent 32-year-old man

Pustular erythema multiforme major associated with atypical pneumonia

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