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Nakayama Y, Yamanouchi M, Mizuno H, Suwabe T, Sekine A, Ikuma D, Hasegawa E, Oba Y, Kono K, Kinowaki K, Ohashi K, Wada T, Sawa N, Ubara Y. Syphilis-related Membranous Nephropathy in a 35-year-old Woman. Intern Med 2024; 63:1429-1432. [PMID: 37839882 PMCID: PMC11157313 DOI: 10.2169/internalmedicine.2380-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023] Open
Abstract
A 35-year-old woman was admitted for the examination of lower leg edema and proteinuria. A kidney biopsy showed membranous nephropathy (MN) with fine granular deposits of IgG along the glomerular capillary and poor spike formation, differing from primary MN in the presence of positive IgG3 and C1q. Lupus nephritis was excluded because serum complement and anti-dsDNA antibody, anti-Smith antibody, and anti-cardiolipin antibody tests were negative. The serological test for syphilis was positive, as was the Treponema pallidum hemagglutination test. The patient was diagnosed with syphilis, and the proteinuria disappeared with antibiotic treatment. In MN with positive IgG3 and C1q, syphilis nephropathy may be a differential diagnosis.
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Affiliation(s)
- Yuki Nakayama
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Masayuki Yamanouchi
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Hiroki Mizuno
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Tatsuya Suwabe
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Akinari Sekine
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Daisuke Ikuma
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Eiko Hasegawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yuki Oba
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital Kajigaya, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Takehiko Wada
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Naoki Sawa
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
| | - Yoshifumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya, Japan
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Taniguchi M, Endo T, Asou M, Tsukamoto T. Nephrotic "full-house" glomerulonephritis successfully treated with antibiotics alone in secondary syphilis: a case report. CEN Case Rep 2024; 13:86-92. [PMID: 37351772 PMCID: PMC10982175 DOI: 10.1007/s13730-023-00803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
A Japanese female in her twenties developed general edema with heavy proteinuria, and was referred to our hospital. She exhibited the common clinical manifestation of idiopathic nephrotic syndrome with massive proteinuria (20.37 g/day), hypoalbuminemia (1.8 g/dL), and hypercholesterolemia (300 mg/dL). Routine admission tests were positive results for both the rapid plasma reagin latex agglutination test for syphilis (RPR) and the Treponema pallidum particle agglutination assay (TPHA). As such, we made her a diagnosis of nephrotic syndrome due to secondary syphilis. Renal biopsy revealed "full-house" nephropathy. Following the commencement of penicillin treatment, she developed skin rash, indicating the Jarisch-Herxheimer reaction (JHR). Her nephrotic syndrome responded rapidly and she achieved complete remission with antibiotic therapy alone after 4 weeks. In light of the increasing incidence of syphilis in Japan, clinicians should consider syphilis as a reversible cause of nephrotic syndrome.
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Affiliation(s)
- Misaki Taniguchi
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Tomomi Endo
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Mea Asou
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology and Dialysis, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20 Ohgimachi, Kita-Ku, Osaka, 530-8480, Japan
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3
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Yang CC, Chen JY, Chang HY, Sheu MJ, Feng IC, Wang SH, Kuo HT. Cholestatic Hepatitis with Concomitant Nephrotic Syndrome due to Secondary Syphilis in a Young Man. Case Rep Gastroenterol 2024; 18:136-143. [PMID: 38501149 PMCID: PMC10948170 DOI: 10.1159/000537922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Syphilis, an ancient sexually transmitted disease, is recognized as a systemic infection disease manifesting with diverse symptoms and variations. Secondary syphilis characterized by systemic symptoms resulted from hematogenous and lymphatic dissemination of the infection, may include manifestations such as hepatitis and nephrotic syndrome. However, the simultaneous occurrence of hepatitis and nephrotic syndrome in secondary syphilis is rare. Case Presentation A young man presented with fatigue, abnormal liver function tests, and hyperbilirubinemia and had history of men who have sex with men (MSM). Serological tests confirmed the diagnosis of secondary syphilis, and kidney biopsy indicated membranous nephritis. After antibiotic treatment, the patient experienced resolution of proteinuria, and liver enzyme levels returned to normal. Conclusion Syphilis should be considered in the differential diagnosis of simultaneous liver and kidney dysfunction, particularly in patients engaging in high-risk sexual behavior. This case highlights the importance of considering syphilis in young patients with MSM and presenting with unexplained nephrotic syndrome and liver abnormalities.
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Affiliation(s)
- Chun-Chi Yang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsuan-Yuan Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jen Sheu
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - I-Che Feng
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Su-Hung Wang
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Fan SL, Landgren A, Ruderman I. Syphilis as the great mimicker: A case of full-house pattern membranous nephropathy. Nephrology (Carlton) 2024; 29:18-20. [PMID: 37723888 DOI: 10.1111/nep.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
Syphilis is a known cause of membranous nephropathy. We describe a case of a patient presenting with nephrotic syndrome whose renal biopsy demonstrated a 'full house' immunohistochemical pattern with positive IgG, IgM, C1q, IgA, C3c, and C4d staining. He was treated with immunosuppressive agents for minimal change nephropathy and subsequently class V lupus nephritis, before syphilis infection was confirmed. Following treatment with a single dose of intramuscular benzathine penicillin there was complete and rapid resolution of nephrotic syndrome. With progressive rising incidence in the western world, syphilis is an important and under-recognised differential diagnosis in cases of nephrotic syndrome.
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Affiliation(s)
- Shu Ling Fan
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anthony Landgren
- Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Irene Ruderman
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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5
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Kaiga A, Sato Y, Arakawa H, Rai T, Tojo A. Crescentic glomerulonephritis associated with syphilis: a case report and review of the literature. J Med Case Rep 2023; 17:549. [PMID: 38129918 PMCID: PMC10740279 DOI: 10.1186/s13256-023-04293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Crescentic glomerulonephritis with syphilis infection is rare, and the mechanism underlying the formation of glomerular capillary wall damage-induced crescent has not been elucidated. CASE PRESENTATION A 62-year-old Japanese male showed edema, eruption, and rapid deterioration of the renal function after an acute syphilis infection. A renal biopsy showed crescentic glomerulonephritis with C3 deposition in the glomerular capillary wall, and immunostaining for anti-Treponema pallidum antibody was weakly positive in some interstitium and one glomerulus. Electron microscopy revealed the presence of string-shaped structures in the glomerular capillary walls. After treatment with penicillin followed by prednisolone, the renal function and urinary abnormalities, including Treponema pallidum protein, disappeared. CONCLUSIONS Crescentic glomerulonephritis associated with syphilis showed a string-shaped deposition in the glomerular capillary and urinary Treponema pallidum protein excretion, and was effectively treated with penicillin and prednisolone.
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Affiliation(s)
- Akiko Kaiga
- Department of Nephrology & Hypertension, Dokkyo Medical University, 880 Kitakobayashi, Mubu, Tochigi, Japan
| | - Yuka Sato
- Department of Nephrology & Hypertension, Dokkyo Medical University, 880 Kitakobayashi, Mubu, Tochigi, Japan
| | - Haruna Arakawa
- Department of Nephrology & Hypertension, Dokkyo Medical University, 880 Kitakobayashi, Mubu, Tochigi, Japan
| | - Tatemitsu Rai
- Department of Nephrology & Hypertension, Dokkyo Medical University, 880 Kitakobayashi, Mubu, Tochigi, Japan
| | - Akihiro Tojo
- Department of Nephrology & Hypertension/Blood Purification Center, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mubu, Tochigi, 321-0293, Japan.
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6
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Aal Hamad A, Al Hadhrami Z, Al Lawati A, Al Busaidi I, Mahmood S. Syphilis-Related Nephropathy: A Rare Manifestation of a Re-emerging Disease. Cureus 2023; 15:e50105. [PMID: 38186493 PMCID: PMC10771031 DOI: 10.7759/cureus.50105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Syphilis is a curable sexually transmitted infection caused by the spirochete Treponema pallidum. Its clinical manifestations are variable as it has a remarkable aptitude to imitate a spectrum of clinical pictures. This phenomenon has bestowed upon it the epithet "the great imitator" within the medical literature. The escalating global prevalence of syphilis cases underscores the importance of shedding light on its rare manifestations. Syphilitic nephropathy is an uncommon manifestation of secondary syphilis. Here, we report two cases of syphilis-related nephropathy, the first presented as a nephrotic syndrome, and the second as a nephritic syndrome. Both cases had a favorable outcome after treatment of syphilis with benzathine penicillin G.
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Affiliation(s)
- Aya Aal Hamad
- Emergency Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | | | - Ali Al Lawati
- Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | | | - Saja Mahmood
- Medicine, Sultan Qaboos University Hospital, Muscat, OMN
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7
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Inayat F, Almas T, Bokhari SRA, Muhammad A, Sharshir MA. Membranous Glomerulonephritis as an Uncommon Presentation of Secondary Syphilis: A Reminder on Therapeutic Decision-Making in Clinical Practice. J Investig Med High Impact Case Rep 2021; 8:2324709620967212. [PMID: 33078640 PMCID: PMC7594254 DOI: 10.1177/2324709620967212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Faisal Inayat
- Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Aun Muhammad
- Allama Iqbal Medical College, Lahore, Punjab, Pakistan
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8
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Anton Pampols P, Espejo-Herrera N, Coloma A. Membranous nephropathy related to secondary syphilis. Med Clin (Barc) 2021; 157:596-597. [PMID: 33858673 DOI: 10.1016/j.medcli.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Paula Anton Pampols
- Servicio Nefrología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
| | - Nadia Espejo-Herrera
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Ana Coloma
- Servicio Nefrología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
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9
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Syphilis-Associated Acute Renal Failure and Hepatitis in the Setting of Human Immunodeficiency Virus Coinfection. Sex Transm Dis 2020; 46:816-818. [PMID: 31764769 DOI: 10.1097/olq.0000000000001062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two individuals with human immunodeficiency virus presented in acute renal failure with nephrotic range proteinuria and were diagnosed with secondary syphilis. One of them also had elevated transaminases. Kidney biopsies revealed membranous nephropathy, a rare complication of secondary syphilis, in both cases. Normal hepatic and renal function were restored after treatment with penicillin.
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10
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van Herwerden MC, Wijnen M, Smedts FMM, Ellerbroek LJ, Huisman SJ. Nephrotic Syndrome and a Maculopapular Rash. Am J Kidney Dis 2020; 73:A13-A16. [PMID: 30905362 DOI: 10.1053/j.ajkd.2018.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/12/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mark Wijnen
- Department of Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Frank M M Smedts
- Department of Pathology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - L Jacobien Ellerbroek
- Department of Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands; Department of Infectious Diseases, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Sebastiaan J Huisman
- Department of Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands; Department of Nephrology, Reinier de Graaf Gasthuis, Delft, the Netherlands
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11
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Zhang Z, Hever A, Bhasin N, Kujubu DA. Secondary Syphilis Associated with Membranous Nephropathy and Acute Hepatitis in a Patient with HIV: A Case Report. Perm J 2018; 22:17-062. [PMID: 29236656 DOI: 10.7812/tpp/17-062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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Affiliation(s)
- Zhou Zhang
- Pulmonary and Critical Care Fellow at the Cedars-Sinai Medical Center and at the Los Angeles Medical Center in CA.
| | - Aviv Hever
- Surgical and Renal Pathologist in the Department of Pathology at the Los Angeles Medical Center in CA.
| | - Nitin Bhasin
- Staff Nephrologist at California Kidney Specialists in Monrovia, CA.
| | - Dean A Kujubu
- Nephrology Fellowship Program Director at the Los Angeles Medical Center in CA.
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12
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Nobakht E, Cohen SD, Rosenberg AZ, Kimmel PL. HIV-associated immune complex kidney disease. Nat Rev Nephrol 2016; 12:291-300. [PMID: 26782145 DOI: 10.1038/nrneph.2015.216] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The introduction in the late 20(th) century of combination antiretroviral therapy (cART) to treat patients infected with HIV has changed the natural history of the disease from an acute illness that rapidly culminates in death, to a chronic condition that can be managed with medications. Over the past decade the epidemiology of kidney disease in US patients infected with HIV has changed, perhaps because of the increased availability and use of cART. Patients with HIV infection exhibit unique immunologic characteristics, including immunodeficiency and dysregulation of immunoglobulin synthetic responses and T-cell function, which can result in glomerular immune complex deposition and subsequent kidney injury. This Review examines the differential diagnoses of HIV-associated immune complex kidney diseases (HIVICD), and discusses the clinical manifestations and mechanisms underlying their development. We address the issues associated with treatment, clinical outcomes, and research needs to enhance our ability to diagnose and optimally treat patients with HIVICD.
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Affiliation(s)
- Ehsan Nobakht
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #3-438, Washington, District of Columbia 20037, USA
| | - Scott D Cohen
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #3-438, Washington, District of Columbia 20037, USA
| | - Avi Z Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, Maryland 21287, USA
| | - Paul L Kimmel
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW #3-438, Washington, District of Columbia 20037, USA
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Abstract
The kidney is involved in a wide range of bacterial, viral, fungal, and parasitic diseases. In most systemic infections, renal involvement is a minor component of the illness, but in some, renal failure may be the presenting feature and the major problem in management. Although individual infectious processes may have a predilection to involve the renal vasculature, glomeruli, interstitium, or collecting systems, a purely anatomic approach to the classification of infectious diseases affecting the kidney is rarely helpful because most infections may involve several different aspects of renal function. In this chapter, a microbiological classification of the organisms affecting the kidney is adopted. Although they are important causes of renal dysfunction in infectious diseases, urinary tract infections and hemolytic uremic syndrome (HUS) are not discussed in detail because they are considered separately in chapters XX and XX, respectively.
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Affiliation(s)
- Ellis D. Avner
- Department of Pediatrics, Medical College of Wisconsin, Children’s Research Institute, Children’s Hospital, Health System of Wisconsin, Milwaukee, Wisconsin USA
| | - William E. Harmon
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Patrick Niaudet
- Service de Néphrologie Pédiatrique, Hôpital Necker-Enfants Malades, Université Paris-Descartes, Paris, France
| | | | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension, The Heart Institute, Cincinnati Children’s Hospital Medical Center, College of Medicine, Cincinnati, Ohio USA
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14
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Simultaneous nephrotic syndrome and hepatitis in secondary syphilis: case report and review of the literature. CEN Case Rep 2015; 4:223-227. [PMID: 28509108 DOI: 10.1007/s13730-015-0173-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
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.
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15
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Early syphilitic hepatitis concomitant with nephrotic syndrome followed by acute kidney injury. Clin J Gastroenterol 2014; 7:349-54. [PMID: 26185887 DOI: 10.1007/s12328-014-0499-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
Although acute hepatitis and nephrotic syndrome are commonly reported as complications of tertiary syphilis, nephrotic syndrome concomitant with hepatitis in early-stage syphilis is rare. Here, we describe the case of a 46-year-old male who was diagnosed with acute liver dysfunction and nephrotic syndrome after presenting with general malaise, and who subsequently developed acute kidney injury. Laboratory examination showed alkaline phosphatase had a greater magnitude of elevation compared to alanine aminotransferase, suggesting the possibility of syphilitic hepatitis. The rapid plasmin regain test and Treponema pallidum hemagglutination assay were positive, supporting the presence of a syphilis infection. Additionally, liver biopsy examination showed infiltration of inflammatory cells into the portal area and epithelioid cell granulomas. Moreover, kidney biopsy examination by both optical and electron microscopy showed a congestion of neutrophils in the capillary vessels, structural collapse of the tubules, and subepithelial deposits under the epithelium of the glomerular endothelial cells. These pathological changes were consistent with those reported previously for early syphilitic hepatitis and nephrotic syndrome in early-stage syphilis. All the symptoms, including liver and renal dysfunction, resolved after benzyl penicillin treatment was initiated. Hence, we believe early-stage syphilis should be included in the differential diagnosis of unknown liver damage and/or nephrosis.
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16
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Hannawi B, Raghavan R. Syphilis and Kidney Disease: A Case Report and Review of Literature. ACTA ACUST UNITED AC 2014. [DOI: 10.4081/nr.2012.e10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There has been a resurgence in the number of incident cases of syphilis in the United States. Syphilis can affect the kidney and usually causes a glomerular lesion with variable amounts of proteinuria. We present a case of a 24-year old African-American male who presented with both membranous glomerulonephritis and secondary syphilis. His kidney disease resolved after a course of penicillin. Recognizing the association of syphilis and proteinuria is important since antibiotic therapy generally results in complete recovery of the associated nephropathy.
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Affiliation(s)
| | - Rajeev Raghavan
- Department of Medicine and Division of Nephrology, Baylor College of Medicine, Houston, USA
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17
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Hartley AJ, Rajakariar R, Sheaff M, Buckland M, Goh B, O’Connell R. Syphilis masquerading as focal segmental glomerulosclerosis. Int J STD AIDS 2014; 25:529-31. [DOI: 10.1177/0956462413516940] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/04/2013] [Indexed: 11/17/2022]
Abstract
A patient referred to the genitourinary clinic for positive syphilis serology was found to have symptoms and signs of nephrotic syndrome. A renal biopsy showed focal segmental glomerulosclerosis (FSGS). Doxycycline 200 mg twice daily for 28 days coincided with considerable decrease in proteinuria and rise in serum albumin, suggesting a causal relationship.
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Affiliation(s)
- AJ Hartley
- Newham University Hospital, Barts Health NHS Trust, London, UK
| | - R Rajakariar
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Sheaff
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Buckland
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B Goh
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - R O’Connell
- Newham University Hospital, Barts Health NHS Trust, London, UK
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Chen YM, Marcos LA, Liapis H, Steinberg TH, Morrison AR. An unusual cause of membranous glomerulonephritis in a patient with HIV. Int Urol Nephrol 2011; 44:983-6. [PMID: 21437594 DOI: 10.1007/s11255-011-9945-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/10/2011] [Indexed: 11/29/2022]
Abstract
A 68-year old Caucasian male with a past medical history of human immunodeficiency virus (HIV) infection presented with acute oliguric renal failure and maculopapular rash. Renal biopsy demonstrated extensive foot process effacement as well as confluent small subepithelial electron-dense deposits, which is diagnostic of membranous glomerulonephritis. Subsequent serological tests showed venereal disease research laboratory test was positive in both serum and cerebral spinal fluid. Following penicillin treatment, the patient's creatinine returned to baseline 4 weeks later. Secondary membranous glomerulonephritis caused by syphilis in patients with HIV is discussed.
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Affiliation(s)
- Ying Maggie Chen
- Renal Division, Washington University School of Medicine, 8126, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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19
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Canney M, Liu E, Vonthethoff L, Weatherall C, Ong S. Nephrotic syndrome and hepatitis due to acquired syphilis: an uncommon presentation of a re-emerging disease. NDT Plus 2010; 4:67-70. [PMID: 25984108 PMCID: PMC4421643 DOI: 10.1093/ndtplus/sfq194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 10/22/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Leon Vonthethoff
- Department of Anatomical Pathology, South Eastern Area Laboratory Services, St. George Hospital, Sydney, Australia
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20
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Satoskar AA, Kovach P, O'Reilly K, Nadasdy T. An Uncommon Cause of Membranous Glomerulonephritis. Am J Kidney Dis 2010; 55:386-90. [DOI: 10.1053/j.ajkd.2009.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 06/09/2009] [Indexed: 11/11/2022]
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21
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Ronco P, Debiec H. Target antigens and nephritogenic antibodies in membranous nephropathy: of rats and men. Semin Immunopathol 2007; 29:445-58. [PMID: 17899086 DOI: 10.1007/s00281-007-0091-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 08/17/2007] [Indexed: 01/31/2023]
Abstract
Membranous nephropathy, a disease characterized by an accumulation of immune deposits on the outer aspect of the glomerular basement membrane, is the most common cause of idiopathic nephrotic syndrome in white adults. In the rat model of Heymann nephritis, the target antigen of antibodies is megalin, a multiligand receptor expressed at the podocyte cell surface. This review summarizes key findings provided by this experimental model and by our discovery of neutral endopeptidase being the alloantigen involved in neonatal cases of membranous nephropathy. We discuss the role of alloimmunization as a new mechanism of renal disease and the approach that we use to identify new podocyte antigens. We also summarize current knowledge on the mechanism of proteinuria, with special emphasis on the role of complement. In conclusion, substantial progresses have been made in understanding molecular mechanisms of membranous nephropathy, which should lead to novel therapeutic approaches.
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Affiliation(s)
- P Ronco
- INSERM Unit 702, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
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Chen YC, Lee N, Chang CT, Wu MS. Salt loss and hyponatraemia in a patient with syphilitic nephritis. Nephrol Dial Transplant 2005; 20:1248-50. [PMID: 15855196 DOI: 10.1093/ndt/gfh778] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yung-Chih Chen
- Division of Nephrology, Chang Gung Memorial Hospital, 222, Mai-Chin Road, Keelung, Taiwan
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24
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Ronco P, Debiec H. Molecular pathomechanisms of membranous nephropathy: from Heymann nephritis to alloimmunization. J Am Soc Nephrol 2005; 16:1205-13. [PMID: 15800120 DOI: 10.1681/asn.2004121080] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Membranous nephropathy (MN), the most common cause of idiopathic nephrotic syndrome in white adults, is characterized by an accumulation of immune deposits on the outer aspect of the glomerular basement membrane. In Heymann nephritis, the rat experimental model for MN, megalin--the target antigen of the nephritogenic antibodies--is expressed on the surface of podocytes, where immune complexes are formed, leading to complement activation and nephrotic-range proteinuria. However, megalin cannot be held responsible for human MN because it has not been found in human podocytes or detected in subepithelial immune deposits in patients with MN. Several potential antigens have been identified in so-called secondary forms of MN, but there is no real proof that these antigens are pathogenic. In a subgroup of infants with antenatal MN, neutral endopeptidase (NEP) has been identified as the first protein target on human podocytes of nephritogenic antibodies. The infants' mothers became immunized during pregnancy against NEP expressed on syncytiotrophoblastic cells because they were NEP deficient as a result of truncating mutations in the MME gene. Severity of neonatal renal disease was determined by the mothers' IgG response that led to the formation of the membrane attack complex of complement in the subepithelial deposits. Alloimmunization against NEP is a novel pathomechanism of MN that might also account for some cases of MN after renal or bone marrow transplantation. Other types of alloimmunization should be investigated in MN but also in other renal and nonrenal diseases, particularly those that affect the pediatric age.
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Affiliation(s)
- Pierre Ronco
- INSERM Unit 489, Tenon Hôpital (Assistance Publique, Hôpitaux de Paris), 4 rue de la Chine, 75020 Paris, France.
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25
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Tang S, Chan KW, Chan TM, Lai KN. Skin lesions, hepatitis, and nephropathy in a 30-year-old man. Am J Kidney Dis 1999; 34:380-3. [PMID: 10430992 DOI: 10.1016/s0272-6386(99)70374-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Tang
- Pathology, University of Hong Kong, Hong Kong
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26
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Abstract
Syphilis in preschoolers is rarely described in current medical literature, despite the rise in syphilis in both the adult and the pediatric populations during the past decade. Since that time, 3 children between 3 and 4 years of age have been diagnosed with syphilis at the Children's Hospital of Philadelphia. The presentations and clinical manifestations of syphilis in these 3 children are described, and the difficulty in identifying the source of infection is discussed. The presentations of these children included nephrosis and secondary syphilis, the corymbiform and palmar rash of syphilis, and subtle signs of late congenital infection in an otherwise asymptomatic child. One child had documented congenital infection, 1 had probable congenital infection that went untreated, and 1 did not have appropriate neonatal testing documented. None of the children gave a verbal history of sexual abuse, although it is likely that all three cases resulted from sexual abuse. The evaluation of preschool children with syphilis is confounded by the interpretation of acquired infection in consideration of a history of possible or documented congenital disease. The assessment is complicated further by problems with recognition of clinical disease, the inability of young children to provide a history, prenatal and neonatal testing methods used, changes in treatment recommendations made during the past decade, and inadequate follow-up to document cure of congenitally infected infants. With the increase in syphilis seen in recent years, physicians are more likely to encounter preschoolers with syphilis. Our ability to document acquired infection, however, is hampered by the difficulties encountered in following recommended guidelines for evaluation and follow-up and by limitations in interviewing young victims of sexual abuse, which may impair our ability to protect children from additional harm. Understanding the pathophysiology and progression of this disease remains challenging even in this modern era.
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Affiliation(s)
- C W Christian
- Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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Abstract
The placentas of eight infants with congenital syphilis were examined by both immunohistochemical and immunofluorescent techniques. Significant IgM, C3 and rheumatoid factor reactivity were observed in all the syphilitic placentas. We postulate that their presence plays an important role in the evolution of the pathological changes.
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Affiliation(s)
- G R Samson
- Department of Paediatrics, Groote Schuur Hospital, University of Cape Town, RSA
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Abstract
Membranous nephropathy and multiple sclerosis are believed to be mediated by immune mechanisms. A patient is reported with the first described association of membranous nephropathy and multiple sclerosis. Its significance and possible pathogenetic mechanisms are discussed.
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Affiliation(s)
- A Campos
- Department of Pediatrics, University of South Florida, Tampa 33606
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29
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Hruby Z, Kuźniar J, Rabczyński J, Bogucki J, Steciwko A, Weyde W. The variety of clinical and histopathologic presentations of glomerulonephritis associated with latent syphilis. Int Urol Nephrol 1992; 24:541-7. [PMID: 1459832 DOI: 10.1007/bf02550123] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Glomerulonephritis is a well established but rather uncommon complication of latent secondary syphilis. We present three cases of glomerulopathies associated with luetic infection, observed and managed in our institutions in the past three years. They illustrate a variety of clinicopathologic presentations of this nephropathy, from acute nephrotic syndrome through membranous glomerulopathy up to rapidly progressive glomerulonephritis. Regardless of the clinical course and histologic type, they were all characterized by strongly positive results of serologic tests for syphilis. Our observations suggest the necessity of eliminating luetic infection in aetiologic considerations of each newly diagnosed case of nephrotic syndrome.
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Affiliation(s)
- Z Hruby
- Department of Nephrology, Academy of Medicine, Wrocław, Poland
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31
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Blair EK, Sedlack RE, Snyder JP, Lawson JM. Unsuspected syphilitic hepatitis in a patient with low-grade proteinuria and abnormal liver function. Mayo Clin Proc 1990; 65:1365-7. [PMID: 2214883 DOI: 10.1016/s0025-6196(12)62147-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 25-year-old patient was found to have cholestatic liver enzyme abnormalities during assessment for asymptomatic low-grade proteinuria at the US Naval Hospital in Portsmouth, Virginia. These abnormalities persisted for a 6-month period, and an extensive workup, including viral serologic studies, rapid plasma reagin test, iron studies, ceruloplasmin, antimitochondrial, antinuclear, and anti-human immunodeficiency virus antibodies, endoscopic retrograde cholangiopancreatography, and liver biopsy, was unrevealing until serologic tests for syphilis were repeated to evaluate a new onset of urethral discharge. The patient had none of the more characteristic signs of secondary syphilis. The liver enzyme abnormalities rapidly resolved after treatment with penicillin. Syphilis remains the great impostor and still must be considered in the differential diagnosis of unexplained liver enzyme abnormalities, even in a patient with no symptoms or signs of early syphilis.
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Affiliation(s)
- E K Blair
- Naval Medical Clinic, Quantico, Virginia
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Jorizzo JL, McNeely MC, Baughn RE, Cavallo T, Solomon AR, Smith EB. Rabbit model of disseminated syphilis: immunoblot and immunohistologic evidence for a role of specific immune complexes in lesion pathogenesis. J Cutan Pathol 1988; 15:150-60. [PMID: 3294256 DOI: 10.1111/j.1600-0560.1988.tb00535.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Circulating immune complexes (CIC) containing Treponema pallidum proteins have been preliminarily implicated as inducers of a neutrophilic vascular reaction in early human cutaneous lesions of secondary syphilis. To clarify the role of specific CIC in producing cutaneous and renal lesions, 12 rabbits were studied at the following intervals after induction of disseminated syphilis: 20 days (4 rabbits: biopsies of normal and lesional skin for direct immunofluorescence (IMF) for (IgG, IgM, IgA, Clq, C3, C4), fibrin, and T. pallidum proteins; routine histology; and immunoblots of serum for CIC containing T. pallidum proteins); 21 days (4 rabbits: as at 20 days without IMF for T. pallidum protein); 23 days (4 rabbits: as at 20 days without IMF); 30 days (same 12 rabbits restudied with routine histology of normal and lesional skin; kidneys from 4 rabbits removed for routine, IMF, and electron microscopy (EM). Treponemal polypeptide antigen (MW-87 kd) was demonstrated in CIC from rabbits. Routine cutaneous histology showed evolution of lesions from an early neutrophilic vascular reaction to the typical lymphoplasmacytic reaction. IMF showed vessel-based immunoreactants in 3 of the 4 rabbits tested at 20 days and 1 of 4 at 21 days, and T. pallidum proteins in 3 of 4 rabbits at 20 days. Routine histology, IMF, and EM studies of glomeruli showed glomerular abnormalities, but no evidence of immune deposits containing specific T. pallidum protein. Skin and kidney studies of 4 controls were all negative. These data indicate a role for specific immune complexes in the pathogenesis of cutaneous lesions in this rabbit model.
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Affiliation(s)
- J L Jorizzo
- Department of Dermatology, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103
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34
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de Souza EC, Jalkh AE, Trempe CL, Cunha S, Schepens CL. Unusual central chorioretinitis as the first manifestation of early secondary syphilis. Am J Ophthalmol 1988; 105:271-6. [PMID: 3344784 DOI: 10.1016/0002-9394(88)90009-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three young, otherwise healthy patients had a similar picture of unilateral central chorioretinitis associated with severe visual loss. Fluorescein angiography disclosed diffuse leakage under the neurosensory retina in the posterior pole, associated with multifocal areas of staining along the retinal vessels. Systemic examination showed a positive fluorescent treponemal antibody absorption test and a sharp increase in VDRL titers, indicative of active secondary syphilis. The patients responded dramatically to penicillin treatment, with visual recovery and resolution of the fundus lesions.
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Affiliation(s)
- E C de Souza
- Eye Research Institute of Retina Foundation, Boston, Massachusetts 02114
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35
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Börner U, Wizemann V. Therapie mit Albumin. TRANSFUSIONSMEDIZIN 1988. [DOI: 10.1007/978-3-662-10601-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Krane NK, Espenan P, Walker PD, Bergman SM, Wallin JD. Renal disease and syphilis: a report of nephrotic syndrome with minimal change disease. Am J Kidney Dis 1987; 9:176-9. [PMID: 3826066 DOI: 10.1016/s0272-6386(87)80096-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A case of nephrotic syndrome and acute renal failure in a 74-year-old man with latent syphilis is described. A renal biopsy demonstrated focal global sclerosis in three of nine glomeruli, however, the remaining glomeruli revealed typical lesions of minimal change disease. Previous reports of renal involvement in syphilis have described membranous glomerulonephritis, mesangial and endothelial cell proliferative glomerulonephritis, and, recently, rapidly progressive glomerulonephritis. The proteinuria and renal failure resolved after penicillin therapy alone. This response strongly suggested that there was a causal relationship between the syphilis and the nephrotic syndrome. This is the first report of such a relationship.
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McNeely MC, Jorizzo JL, Solomon AR, Smith EB, Cavallo T, Sanchez RL. Cutaneous secondary syphilis: preliminary immunohistopathologic support for a role for immune complexes in lesion pathogenesis. J Am Acad Dermatol 1986; 14:564-71. [PMID: 3514703 DOI: 10.1016/s0190-9622(86)70070-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A circulating immune complex-mediated pathogenesis for lesions of secondary syphilis has been postulated. Textbook descriptions of a lymphoplasmacytic histopathologic picture have contradicted a role for circulating immune complexes in lesion pathogenesis. Four patients with early cutaneous lesions of secondary syphilis were studied. All four patients had serum Raji cell and/or Clq binding assay evidence for circulating immune complexes. Three patients showed a neutrophilic vascular reaction on histologic study of early lesions. The patients studied had immunofluorescence microscopic evidence of immunoreactant deposition in dermal blood vessels (4 hours) and/or a neutrophilic vascular reaction (24 hours) after intradermal histamine injection. Dieterle staining of lesional tissue from all patients showed the presence of treponemal organisms in dermal blood vessels. This new preliminary evidence adds some support to a circulating immune complex-mediated pathogenesis of cutaneous lesions in human secondary syphilis.
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38
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Burkholder PM. Immunopathology of Renal Disease. Clin Lab Med 1986. [DOI: 10.1016/s0272-2712(18)30826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walker PD, Deeves EC, Sahba G, Wallin JD, O'Neill WM. Rapidly progressive glomerulonephritis in a patient with syphilis. Identification of antitreponemal antibody and treponemal antigen in renal tissue. Am J Med 1984; 76:1106-12. [PMID: 6375366 DOI: 10.1016/0002-9343(84)90866-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A 37-year-old man presented with biopsy-proved rapidly progressive glomerulonephritis and a strongly positive fluorescent treponemal antibody result. The patient was treated with hemodialysis, plasmapheresis, methylprednisolone, and penicillin, with rapid improvement and stabilization of renal function. Antibody was eluted from the frozen renal tissue and demonstrated a strongly positive reaction to the treponemal antigen when used in the fluorescent treponemal antibody test. In addition, when specific rabbit antitreponemal antiserum was applied to the frozen renal sections, there was a strongly positive reaction. Although syphilis has been associated with membranous glomerulopathy and post-infectious glomerulonephritis, this appears to be the first case of latent syphilis in which rapidly progressive glomerulonephritis has been identified. The presence within the glomeruli of treponemal antigen and antitreponemal antibody supports the association of these two entities.
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42
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Abdurrahman MB. The role of infectious agents in the aetiology and pathogenesis of childhood nephrotic syndrome in Africa. J Infect 1984; 8:100-9. [PMID: 6373945 DOI: 10.1016/s0163-4453(84)92356-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Childhood nephrotic syndrome is common in Africa where infectious agents are prevalent. This paper reviews the possible aetiological role of infectious agents in childhood nephrotic syndrome in Africa. There is a strong association, possibly causal, between childhood nephrotic syndrome on the one hand and Plasmodium malariae, Schistosoma mansoni and hepatitis B antigens on the other. Beta-haemolytic streptococci are less strongly associated with nephrotic syndrome, and a few other organisms are suspect. The many ubiquitous infectious agents and the prevalence of multiple infections make it difficult to define the role of any single infectious agent or to determine the interaction between the various agents. Control or eradication of infectious diseases should lower the incidence of childhood nephrotic syndrome in Africa.
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43
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 15-1983. A 24-year-old man with cervical lymphadenopathy and the nephrotic syndrome. N Engl J Med 1983; 308:888-96. [PMID: 6835286 DOI: 10.1056/nejm198304143081509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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45
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Abstract
In experimental syphilis, lesion development changes when different numbers of treponemes are injected. Lesions at sites inoculated with lower concentrations frequently exhibit delayed incubation periods, less tissue degradation, and more rapid healing. In this report I describe an unusual finding, namely, that accelerated rather than delayed incubation period occurred after intradermal inoculation of different dosages of Treponema pallidum. When rabbits were injected with only one inoculum containing 10(6), 10(5), 10(4), or 10(3) treponemes per rabbit, the corresponding incubation periods were 4.2, 7.5, 11.0 and 15.3 days, respectively. When each rabbit was injected with all four inocula on the back, the incubation periods were shortened to 3.9, 6.0, 7.0 and 8.9 days, respectively. More pronounced differences were observed with more divergent ranges of treponemal inocula. I discuss these findings in terms of the histopathology of syphilitic lesions.
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46
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Aronson IK, Soltani K, Brickman F. Jarisch-Herxheimer reaction in complement-depleted rabbits. Histological and immunofluorescence studies of early cutaneous lesions. Br J Vener Dis 1981; 57:226-31. [PMID: 7023600 PMCID: PMC1045929 DOI: 10.1136/sti.57.4.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The possible role of complement in the pathogenesis of the Jarisch-Herxheimer reaction was assessed in cutaneous syphilitic lesions in two groups of rabbits treated with penicillin; in one group complement was depleted before penicillin therapy. Serial biopsy specimens were similar histologically in both groups. The activation of the complement pathways did not seem to play a role in the pathogenesis of early cutaneous syphilitic lesions in rabbits during the Jarisch-Herxheimer reaction.
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47
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Chatenoud L, Bach MA. Abnormalities of T-cell subsets in glomerulonephritis and systemic lupus erythematosus. Kidney Int 1981; 20:267-74. [PMID: 6457202 DOI: 10.1038/ki.1981.130] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In this study, three kinds of monoclonal antibodies directed at human T lymphocytes, produced by mouse hybridomas and termed OKT3, OKT4, and OKT8, were used in an indirect immunofluorescence assay, to analyze the distribution of peripheral T lymphocyte subsets in 41 patients with glomerulonephritis (GN) and 11 patients with systemic lupus erythematosus (SLE). As assessed by functional studies, OKT4 and OKT8 defined the helper and cytotoxic/suppressor T lymphocytes subsets, respectively, whereas OKT3 recognized all peripheral T-cells. Among GN patients, the ones presenting membranous GN (MGN), IgA disease, and lipoid nephrosis associated with segmental and focal hyalinosis (FGS) showed significant decrease of their peripheral cytotoxic/suppressive T cells. On the contrary, no significant alteration was found in the peripheral T cell distribution of patients with membranoproliferative GN (MPGN) and lipoid nephrosis associated with minimal-change GN (MCGN). Unexpectedly, there was a tendency for peripheral cytotoxic/suppressive T lymphocytes to be high in the majority of SLE patients, and only two of these subjects exhibited a relative decrease in peripheral OKT8 marked cells. The steroid therapy received by our patients might account for this discrepancy with previous reports of altered suppressor function in active SLE.
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48
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Morrison EB, Norman DA, Wingo CS, Henrich WL. Simultaneous hepatic and renal involvement in acute syphilis. Case report and review of the literature. Dig Dis Sci 1980; 25:875-8. [PMID: 7002507 DOI: 10.1007/bf01338531] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An unusual case of simultaneously occurring acute syphilitic hepatic and renal disease is presented and a concise literature review of both the pathological and clinical findings in this disease is included. Hepatic and renal biopsies were useful in excluding other diagnostic possibilities and in establishing the correct diagnosis in the case presented.
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49
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Riede UN, Sandritter W. [A pathological fantasy. Identification of the "pathogenic agent" in a case of membranous glomerulo nephritis]. Pathol Res Pract 1980; 169:106-8. [PMID: 7433261 DOI: 10.1016/s0344-0338(80)80103-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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50
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Abstract
Serum immune complexes were estimated by a polyethylene glycol precipitation method in 51 patients with early syphilis. The immune complexes were increased in 41% of patients before treatment and decreased to normal limits in only 56% during treatment. The results of the specific antireponemal tests using dissolved immune complexes show that antibodies from the immune complexes are specific antibodies.
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