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Case Reports
. 2021 May 25;22(1):196.
doi: 10.1186/s12882-021-02404-z.

Syphilis-related rapidly progressive glomerulonephritis: a case presentation

A Qi  1 , P O Fiset  2 , L Pilozzi-Edmonds  3
Affiliations
Case Reports

Syphilis-related rapidly progressive glomerulonephritis: a case presentation

A Qi et al. BMC Nephrol. .

Abstract

Background: Syphilis is a multisystemic infection that causes a wide variety of symptoms and thus has been dubbed one of the great medical mimickers. Due to recent global re-emergence of syphilis, it has become important to recognize its various presentations. Relative to the kidney, syphilitic infections generally present themselves with nephrotic range proteinuria, and are most often associated with pathological features of a membranous glomerulonephritis with subepithelial immune complex deposition. However, other rare renal presentations have been reported. One of these includes a rapidly progressive glomerulonephritis picture. All described cases have been successfully resolved with the treatment of the underlying syphilis infection.

Case presentation: The patient was an elderly woman of Caribbean descent who presented with lower extremity weakness, anasarca and proteinuria, hematuria with progressive renal failure. On kidney biopsy, she was found to have a pauci-immune crescentic glomerulonephritis pattern and a concomitant acute tubulointerstitial nephritis. She had a positive Treponema pallidum particle agglutination test and a negative syphilis rapid plasma reagin test with clinical evidence of polyneuropathy suggestive chronic syphilis infection.

Conclusion and discussion: It is important in the context of pauci-immune crescentic glomerulonephritis to explore all differential diagnoses. Given the positive syphilis serologies, clinical context and presence of tubulointerstitial nephritis, she was determined to have syphilitic glomerulonephritis that resolved with a course of both penicillin and steroids.

Keywords: Case report; Hematuria; Proteinuria; Rapidly progressive glomerulonephritis; Syphilis.

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Conflict of interest statement

AQ and LP have no competing interests to declare. POF has no competing interests related to this work to declare. POF has received honoraria from Amgen, EMD Serono, Bristol Myers Squibb, AstraZeneca, Merck Canada, Pfizer Canada, and Roche Canada, outside the submitted work.

Figures

Fig. 1
Fig. 1
a Light microscopy of kidney biopsy showing crescent formation in the glomerulus. Periodic Acid-Schiff stain (400X). b Light microscopy showing tubulointerstitial nephritis with large infiltration of plasma cells and eosinophils. Haematoxylin and Eosin stain (200X) (c) Electron microscopy did not show any significant immune complex deposits (3000X)
Fig. 2
Fig. 2
a Light microscopy of the kidney biopsy core with significant interstitial plasma cell and eosinophil infiltration. H&E 40X. b IgG Immunohistochemistry staining. c IgG4 subclass immunohistochemisty staining (accounting for ~ 50% of IgG staining)
See this image and copyright information in PMC

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