Syphilis-related rapidly progressive glomerulonephritis: a case presentation

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.

Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

“…Similar to our case, in three previously reported cases patient presented with hematuria, proteinuria, and rapidly increasing serum creatinine over a short period. 2 , 3 , 4 There may or may not be associated features suggestive of secondary syphilis.…”

“…1 It can affect every structure of the kidney resulting in glomerulopathies, tubular pathology, and vasculitic lesions in the kidney. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 …”

Atypical presentation of syphilis: rapidly progressive glomerulonephritis

“…Patients present with hematuria, proteinuria, and rapidly increasing serum creatinine over a short period of time. This may or may not be accompanied by other features suggestive of secondary syphilis [2,4]. The pathogenesis consists of immune complex-mediated glomerular injury as evidenced by the presence of treponemal antigens and antibody to Treponemal pallidum on pathologic examination of renal tissue [7].…”

“…Nephrotic range proteinuria due to membranous nephropathy is the most common form. On the other hand, rapidly progressive glomerulonephritis pattern is an atypical and very rare presentation of syphilis, with only three case reports [2][3][4]. We report a case of immunocompetent patient presenting with hematuria, proteinuria and rapidly deteriorating renal function suggestive of RPGN.…”

A wild glomerulonephritis: Rapidly progressive glomerulonephritis associated with diffuse pulmonary hemorrhage.

“…Fujita and Fiset described that renal failure at presentation entails a greater risk of end-stage kidney disease and death regardless of immunosuppressive therapy. 3,4 Nieto et al mention that RPGN can complicate any glomerular disease because it is the result of severe damage that generates rupture of the glomerular capillary walls, a process that induces the proliferation of the different glomerular cells, which induces the formation of crescents which can be visualized during the histopathology study. Additionally, the gravity of the disease is related to the nature and type of immunological process that causes it and partially to the degree of crescent formation.…”