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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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Usmael SA, Gebremedhin TA. Atypical presentation of syphilis: Rapidly progressive glomerulonephritis. Clin Case Rep 2023; 11:e6864. [PMID: 36694644 PMCID: PMC9842786 DOI: 10.1002/ccr3.6864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. With the recent worldwide resurgence of syphilis, it is imperative to recognize various presentations of this great imitator. Renal syphilis is rare and most commonly present as nephrotic range proteinuria associated with pathological features of membranous glomerulonephritis. Rapidly progressive glomerulonephritis (RPGN) is a rare and atypical form of renal syphilis. A 50-year-old Ethiopian woman presented with periorbital swelling, hematuria, proteinuria, and rapidly progressive renal failure. Rapid plasma reagin and confirmatory Treponema pallidum hemagglutination (TPHA) tests were reactive. Treatment with a weekly Benzathine penicillin for 3 weeks resulted in a rapid return of renal function to baseline, with the increasing rate of new syphilis, clinicians should be mindful of the various renal manifestation of syphilis. This case highlights the significance of considering syphilis as a reversible cause in any patient presenting with a clinical feature suggestive of RPGN.
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Affiliation(s)
- Semir Abdi Usmael
- Internal Medicine DepartmentCollege of Health and Medical Sciences, Haramaya UniversityHararEthiopia
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Shettigar R, Schollum J, Putt T, Chan L, Lau M, Walker R. Renal manifestations of syphilis. Intern Med J 2021; 51:1160-1167. [PMID: 34278696 DOI: 10.1111/imj.15407] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 01/26/2023]
Abstract
Syphilis is a sexually transmitted disease caused by spirochaete Treponema pallidum. The incidence of syphilis is rising across the globe. It has been described in the literature as a great imitator due to the vast range of clinical manifestations that can occur in the disease. Renal manifestations are rare but a feature of secondary syphilis. It can cause glomerulopathies, tubular pathology and vasculitic lesions in the kidney. Membranous nephropathy is the most commonly reported glomerular lesion associated with syphilis. With two recent cases of secondary membranous nephropathy due to syphilis, it is timely to review the current state of knowledge, and discuss the different renal manifestation of syphilis, its pathology and treatment options.
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Affiliation(s)
| | | | - Tracey Putt
- Nephrology, Dunedin Public Hospital, Dunedin, New Zealand
| | - Ling Chan
- Pathology, Southern Community Laboratories, Dunedin, New Zealand
| | - Michael Lau
- Pathology, Southern Community Laboratories, Dunedin, New Zealand
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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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Jaunin E, Kissling S, Rotman S, Waeber G, Halfon M. Syphilis and parvovirus B19 co-infection imitating a lupus nephropathy: A case report. Medicine (Baltimore) 2019; 98:e17040. [PMID: 31490394 PMCID: PMC6739001 DOI: 10.1097/md.0000000000017040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Syphilis can share clinical features with autoimmune diseases, such as cutaneous Lupus or rheumatoid arthritis. Moreover, secondary syphilis can have visceral involvement, thus affecting the kidney. Syphilitic nephropathy causes nephrotic syndrome with a classic membranous pattern. We present a unique presentation of a co-infection by syphilis and parvovirus B19 sharing all the biological and histological features of proliferative lupus nephritis (LN). PATIENT CONCERNS We present a case of a 71-year-old Caucasian male returning from a trip to Asia presenting with nephrotic syndrome with antinuclear antibodies (ANA) positivity. DIAGNOSES Because of nephrotic syndrome a kidney biopsy was performed. It demonstrated a membranous nephropathy with extracapillary proliferation and a full house pattern (presence of IgA, IgG, IgM and C1Q deposits) on immunofluorescence (IF), highly suggestive of LN class III and V. However, several atypical clinical features notably the age, sex of the patient and the history of travel prompt us to search for another cause of nephropathy. INTERVENTIONS A serology was positive for syphilis and a PCR in the renal biopsy was also positive for parvovirus B19. Thus, a co-infection by syphilis and parvovirus B19 was funded to be the cause of the renal lesions. OUTCOMES The proteinuria improved; a course of antibiotic was administrated because of neurologic syphilitic involvement (presence of headache with positive syphilis serology in the CSF). LESSONS A co-infection by syphilis and parvovirus B19 can share all the biological and histological features of proliferative LN and must be recognized as a cause of pseudo-lupus nephritis.
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Affiliation(s)
| | | | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital and University of Lausanne, Switzerland
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Orozco Guillén AO, Velazquez Silva RI, Moguel González B, Guell YA, Garciadiego Fossas P, Custodio Gómez IG, Miranda Araujo O, Soto Abraham V, Piccoli GB, Madero M. Acute IgA-Dominant Glomerulonephritis Associated with Syphilis Infection in a Pregnant Teenager: A New Disease Association. J Clin Med 2019; 8:jcm8010114. [PMID: 30669309 PMCID: PMC6352144 DOI: 10.3390/jcm8010114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) is increasingly recognized as a risk factor in pregnancy; the differential diagnosis between CKD and preeclampsia (PE) may be of pivotal importance for pregnancy management and for early treatment of CKD. Acknowledging this connection may be useful also in a wider context, such as in the case reported in this paper, which for the first time describes an association between syphilis infection and IgA-dominant glomerulonephritis. A 16-year-old woman, referred to a general hospital due to a seizure, was found to be unknowingly pregnant. Based on hypertension and nephrotic proteinuria, she was initially diagnosed with PE. Immunological tests, as well as hepatitis and HIV tests showed negative results. However, secondary syphilis was diagnosed. In discordance with the PE diagnosis, urinalysis showed glomerular microhematuria with cellular casts. Proteinuria and hypertension did not remit after delivery, which was made via caesarean section, due to uncontrolled hypertension, at an estimated gestational age of 29 weeks. A male baby, weighing 1.1 kg (6.5 centile) was born. The baby was hospitalized in the neonatal intensive care unit, where he developed subependymal hemorrhage and thrombocytopenia, and neonatal syphilis was diagnosed. The mother underwent a kidney biopsy one week after delivery, leading to the diagnosis of IgA-dominant postinfectious glomerulonephritis. Mother and child were treated with support and antibiotic therapy, and were discharged in good clinical conditions four weeks later. Four months after delivery, the mother was normotensive without therapy, with normal kidney function and without hematuria or proteinuria. In conclusion, this case suggests that IgA-dominant postinfectious glomerulonephritis should be added to the spectrum of syphilis-associated glomerulonephritides, and underlines the need for a careful differential diagnosis with CKD in all cases of presumed PE. While diagnosis relies on kidney biopsy, urinary sediment, a simple and inexpensive test, can be the first step in distinguishing PE from other nephropathies.
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Affiliation(s)
| | | | - Bernardo Moguel González
- Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14080, Mexico.
| | - Yubia Amaya Guell
- Department of Foetal Medicine, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico.
| | - Pamela Garciadiego Fossas
- Department of Infectolog, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico.
| | - Iris Guadalupe Custodio Gómez
- Department of Gynaecology and Obstetrics, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico.
| | - Osvaldo Miranda Araujo
- Department of Gynaecology and Obstetrics, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City 11000, Mexico.
| | - Virgilia Soto Abraham
- Department of Pathology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14000, Mexico.
| | - Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences University of Torino, 10043 Torino, Italy.
- Department of Nephrology, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Magdalena Madero
- Department of Pathology, National Institute of Cardiology "Ignacio Chávez", Mexico City 14000, Mexico.
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Osbak KK, Van Raemdonck GA, Dom M, Cameron CE, Meehan CJ, Deforce D, Ostade XV, Kenyon CR, Dhaenens M. Candidate Treponema pallidum biomarkers uncovered in urine from individuals with syphilis using mass spectrometry. Future Microbiol 2018; 13:1497-1510. [PMID: 30311792 DOI: 10.2217/fmb-2018-0182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM A diagnostic test that could detect Treponema pallidum antigens in urine would facilitate the prompt diagnosis of syphilis. MATERIALS & METHODS Urine from 54 individuals with various clinical stages of syphilis and 6 controls were pooled according to disease stage and interrogated with complementary mass spectrometry techniques to uncover potential syphilis biomarkers. RESULTS & CONCLUSION In total, 26 unique peptides were uncovered corresponding to four unique T. pallidum proteins that have low genetic sequence similarity to other prokaryotes and human proteins. This is the first account of direct T. pallidum protein detection in human clinical samples using mass spectrometry. The implications of these findings for future diagnostic test development is discussed. Data are available via ProteomeXchange with identifier PXD009707.
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Affiliation(s)
- Kara K Osbak
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Geert A Van Raemdonck
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Laboratory for Protein Science, Proteomics & Epigenetic Signalling & Centre for Proteomics, University of Antwerp, Wilrijk, Belgium
| | - Martin Dom
- Laboratory for Protein Science, Proteomics & Epigenetic Signalling & Centre for Proteomics, University of Antwerp, Wilrijk, Belgium
| | - Caroline E Cameron
- Department of Biochemistry & Microbiology, University of Victoria, Victoria, British Columbia, Canada
| | - Conor J Meehan
- Department of Biomedical Sciences, Institute for Tropical Medicine, Antwerp, Belgium
| | - Dieter Deforce
- Laboratory for Pharmaceutical Biotechnology, Ghent University, Ghent, Belgium
| | - Xaveer Van Ostade
- Laboratory for Protein Science, Proteomics & Epigenetic Signalling & Centre for Proteomics, University of Antwerp, Wilrijk, Belgium
| | - Chris R Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Division of Infectious Diseases & HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Maarten Dhaenens
- Laboratory for Pharmaceutical Biotechnology, Ghent University, Ghent, Belgium
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Wikonkál N, Nagy P, Tóth B, Marschalkó M, Tislér A, Kárpáti S. [Syphilitic glomerulonephritis: case report and review of the literature]. Orv Hetil 2015; 156:32-5. [PMID: 25544053 DOI: 10.1556/oh.2015.30082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors report the history of a patient with syphilitic glomerulonephritis, a rare complication of syphilis. The patient was admitted to the hospital with clinical symptoms of neurosyphilis. During his hospital stay urine analysis revealed an extremely high proteinuria, that had not been known before. Intravenous penicillin treatment improved the renal protein loss, but it took a total of six months until complete resolution was achieved. The serology that confirmed the syphilis, the concomitant nephrotic syndrome and the improvement after penicillin therapy met the criteria of syphilitic glomerulonephritis. This case prompted the authors to review the literature about this rare complication of syphilis that has a great clinical significance.
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Affiliation(s)
- Norbert Wikonkál
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Patrícia Nagy
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Béla Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - András Tislér
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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