Syphilis: a reversible cause of nephrotic syndrome

Abstract

A patient in his late 30s presented with symptoms consistent with a nephrotic syndrome. Renal biopsy revealed membranous nephropathy. He also mentioned a spontaneous resolving 'rash' at his glans penis after unprotected intercourse. Therefore, he was tested for sexually transmitted diseases as a possible underlying cause of his nephrotic syndrome. Serology for syphilis was positive with high titres. After a single penicillin injection, there was fast and complete clinical recovery.

Figure 1

(A) In light microscopy, barely discernible irregularities in the glomerular basement membrane were observed with, again, barely discernible subepithelial eosinophilic deposits along the outer subepithelial rim (blue arrows); no spikes are visible at this stage (methenamine silver stain, ×40 original magnification); (B) electromicroscopy confirmed the presence of electron dense deposits (representing immune complex deposits; white arrows) on the outer subepithelial side of the glomerular basement membrane (black arrows). Podocytes show the effacement of foot processes (End,  endothelium; Pod, podocyte; L, capillary lumen; ×10 000 original magnification).