Resolution of syphilis-related rapidly progressive glomerulonephritis with penicillin therapy: Case report

Nandikanti, Deepak K.; George, Lekha K.; Walker, Patrick D.; Kumar, Aneel; Wall, Barry M.

doi:10.5414/cn109847

Cited by 8 publications

(15 citation statements)

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“…Background vascular findings were attributed to the patient’s diabetes type 2 and hypertension. Our biopsy findings being similar to Nandikanti et al [ 1 ] and given the clinical context, this presentation was most likely due to syphilitic infection. Absence of hypocomplementemia and of other organ involvement (thoraco-abdominal and pelvic computerized tomography showed no abnormalities) made IgG4-related disease and tubulointerstitial nephritis unlikely based on the proposed diagnostic criteria for IgG4-related disease [ 7 , 8 ].…”

Section: Case Presentationsupporting

confidence: 89%

“…It is important to consider the clinical context and send for the appropriate serological tests. In the case of syphilis, given the symptoms may be non-specific and mild, it is important to send a syphilis screen in the context of nephrotic range proteinuria and, as this case presentation and others have shown [ 1 , 3 ], in the context of active urine sediment with hematuria and proteinuria. Timing is crucial, especially in crescentic-necrotizing renal disease - the earlier the diagnosis, the greater the chance of regression of crescent formation and thereby the greater the chance of renal recovery.…”

Section: Discussionmentioning

confidence: 99%

“…As for immunosuppression with steroids, given the paucity of cases in literature of syphilitic RPGN, it is unknown whether steroids are beneficial for induction in the acute treatment phase. Two case reports have successfully treated with penicillin alone [ 1 , 2 ]. Walker et al treated a patient with RPGN who required dialysis with both penicillin and methylprednisolone [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most common infections being post-streptococcal glomerulonephritis caused by streptococcal infection and membranoproliferative glomerulonephritis caused by viral infections such as hepatitis. However, a much rarer cause is syphilis, with only three reported cases [ 1 – 3 ]. Generally, syphilitic infection has been associated with nephrotic-range proteinuria caused by membranous glomerulonephritis [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Syphilis-related rapidly progressive glomerulonephritis: a case presentation

Fiset

Pilozzi-Edmonds

2021

BMC Nephrol

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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.

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Section: Case Presentationsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Syphilis-related rapidly progressive glomerulonephritis: a case presentation

Fiset

Pilozzi-Edmonds

2021

BMC Nephrol

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“…Second, T. pallidum can invade any organ, including the urinary tract and kidney ( 24 – 27 ). Latent or secondary syphilis-associated glomerulonephritis and nephrotic syndrome have been reported ( 23 – 28 ) as well. Thus, T. pallidum invading urinary systems could be excreted into the urine.…”

Section: Discussionmentioning

confidence: 99%

Quantified Detection of Treponema pallidum DNA by PCR Assays in Urine and Plasma of Syphilis Patients

et al. 2022

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Syphilis is a sexually transmitted disease caused by Treponema pallidum sub. pallidum. T. pallidum can invade many organs, and T. pallidum DNA can be detected in various tissues and fluids. The results reported here demonstrated that T. pallidum DNA could be detected in urine in patients at all stages of syphilis.

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Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Usmael

Gebremedhin

2023

Clinical Case Reports

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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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Resolution of syphilis-related rapidly progressive glomerulonephritis with penicillin therapy: Case report

Cited by 8 publications

References 0 publications

Syphilis-related rapidly progressive glomerulonephritis: a case presentation

Syphilis-related rapidly progressive glomerulonephritis: a case presentation

Quantified Detection of Treponema pallidum DNA by PCR Assays in Urine and Plasma of Syphilis Patients

Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

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