Secondary Syphilis With Hepatitis and Nephrotic Syndrome: A Rare Concurrence

Abstract

Syphilis, a chronic multisystem disease, is caused by a spirochete, Treponema pallidum. Clinical presentation may expand to several stages including primary, secondary and latent syphilis, which may present as early or late syphilis. Nephrotic syndrome and acute hepatitis are well-known complications of secondary syphilis. To the best of our knowledge, secondary syphilis with coexisting renal and hepatic complications has rarely been reported. Here we present a rare case of concurrent nephrotic syndrome and acute hepatitis in a patient with secondary syphilis.

A case of secondary syphilis manifesting as a pulmonary pseudo-tumour with nephrotic syndrome

“…Furthermore, renal syphilis with concomitant hepatic involvement in itself is also exceptionally rare with only seven cases described in the literature. [3] The case we report not only fulfills the five criteria for diagnosis of pulmonary syphilis, but to our knowledge, illustrates the first case of pulmonary syphilis with nephrotic syndrome. Additionally, the raised liver enzymes suggest concomitant liver involvement – adding to the uniqueness of this case.…”

“…Syphilis, also known as ‘The Great Imitator’, was first described in 1530 by Hieronymus Fracastorius. The association with T. pallidum was later made in 1905 by Schaudinn and Hoffman [3] when they identified the bacteria in syphilitic lesions.…”

Membranous Glomerulonephritis as an Uncommon Presentation of Secondary Syphilis: A Reminder on Therapeutic Decision-Making in Clinical Practice

“… 17 , 18 Notably, patients with syphilitic nephropathy may also concurrently develop acute hepatitis. 19 - 23 Given the possibility of deranged hepatic function, liver function testing is important. Furthermore, a detailed clinical history, especially information regarding safer sex practices, is pertinent in these patients.…”

Cholestatic hepatitis with concomitant nephrotic syndrome due to late syphilis in an immunocompetent 32-year-old man

“…Focusing on hepatic involvement of syphilis infection, syphilitic hepatitis can be observed in approximately 0.2%–3% of all patients with secondary syphilis 4 8 9…”

“…Hepatosplenomegaly is often found on physical examination and imaging. Histological analysis of liver biopsies mostly shows a lymphocytic pericholangiolar and periportal inflammation, focal necrosis of hepatocytes within the periportal or centrilobular region, a Kupffer cell hyperplasia and granulomatous changes 1 3 4 9 12. Sometimes, spirochetes can be observed within the sinusoids 10.…”