Simultaneous nephrotic syndrome and hepatitis in secondary syphilis: case report and review of the literature

Abstract

A 66-year-old man presented with a penile ulcer, an acute clinical onset of nephrotic syndrome and hepatitis. Secondary syphilis was diagnosed on the basis of the history of rash and the result of strongly positive serological test for syphilis. A renal biopsy demonstrated membranous glomerulonephritis with subepithelial electron-dense deposits. After treatment with amoxicillin for 2 weeks, he achieved clinical recovery. It is important to recognize syphilis as a reversible cause of nephrotic syndrome and acute hepatitis because antibiotic therapy can result in complete remission.

Keywords: Hepatitis; Membranous glomerulonephritis; Nephrotic syndrome; Syphilis.

Fig. 1

a Hematoxylin and eosin (H&E)-stained slides of kidney biopsy: essentially normal except a double contour of glomerular basement membrane (black arrow). b Subepithelial and intramembranous electron-dense immune-type deposits with differences in size and density (Ehrenreich and Churg glomerular stage I). c, d Direct immunofluorescence (DIF) showed bright diffuse granular glomerular capillary wall staining for IgG and C3

Fig. 2

Clinical course