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Case Reports
. 2018:22:17-062.
doi: 10.7812/TPP/17-062.

Secondary Syphilis Associated with Membranous Nephropathy and Acute Hepatitis in a Patient with HIV: A Case Report

Zhou Zhang  1 , Aviv Hever  2 , Nitin Bhasin  3 , Dean A Kujubu  4
Affiliations
Case Reports

Secondary Syphilis Associated with Membranous Nephropathy and Acute Hepatitis in a Patient with HIV: A Case Report

Zhou Zhang et al. Perm J. 2018.

Abstract

Introduction: We present a case of membranous nephropathy associated with a secondary syphilis infection in a patient with HIV.

Case presentation: A 37-year-old white man with HIV who was receiving highly active antiretroviral therapy presented to the Emergency Department with 6 weeks of rectal pain. He had a CD3-CD4 count of 656 cells/mm3 and an undetectable viral load. On admission, he was found to have an anal ulcer, a serum creatinine of 1.4 mg/dL (baseline 0.7 to 1.0 mg/dL), elevated transaminases, positive rapid plasmin reagin, and a urine protein/creatinine ratio revealing nephrotic-range proteinuria. Renal biopsy demonstrated membranous nephropathy with features suggestive of a secondary cause. Our patient was treated with penicillin for secondary syphilis, with normalization of renal function, resolution of the nephrotic syndrome, and improvement of his elevated transaminases.

Discussion: This case is a reminder that patients with HIV are not infrequently coinfected with Treponema pallidum and that secondary syphilis can have systemic manifestations, including elevated transaminases and nephrotic syndrome. Prompt diagnosis and treatment will result in resolution of these problems.

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Conflict of interest statement

Disclosure Statement

The author(s) have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Renal biopsy by light microscopy, A) periodic acid-Schiff stain and B) Jones silver stain, showing mild acute tubular necrosis and mild arterial and arteriolar nephrosclerosis.
Figure 2
Figure 2
Renal biopsy by immunofluorescence microscopy, showing positive staining for immunoglobulin G, immunoglobulin M, C3, C1q, and kappa and lambda light chains in the capillary walls and mesangial regions.
Figure 3
Figure 3
Renal biopsy by electron microscopy. Arrows indicate subepithelial electron-dense deposits in the subepithelial and paramesangial regions.
See this image and copyright information in PMC

References

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