The Great Imitator: Secondary Syphilis Presenting as Nephrotic Syndrome with Recurrent Skin Rash

Cheng-Hsu Chen ； Yu-Hui Lin ； Chien-Shan Chiu ； Mei-Chin Wen

《Acta Nephrologica》 31卷2期 (2017/06) Pp. 84-87

https://doi.org/10.6221/AN.2017002

摘要

Syphilis is difficult to be early diagnosed clinically in its presentation, and the diagnosis of secondary syphilis is particularly challenging. Secondary syphilis manifests most commonly in the skin, mucous membranes, and lymph nodes, but rarely also becomes as a cause of kidney disease. We report a 26-year-old man who presented with sudden onset of nephrotic syndrome, inguinal lymphoadenopathy, and recurrence of atypical skin rash over the whole trunk and limbs, but not the face. The laboratory data disclosed heavy proteinuria 18.75 gm/day. Renal biopsy demonstrated with unremarkable findings under light microscopy, but immunofluorescent examination revealed a granular deposition of IgG and IgA along the glomerular capillary basement membrane with complement activation, and electron-dense deposits located in the subepithelial area disclosed by electron microscopy indicated stage 1 membranous nephropathy (MN). High reactive serum rapid plasma reagin (RPR) at 64 dilutions and FTA-ABS (Fluorescent Treponemal Antibody Absorption) at 2,560 dilutions were consistent with syphilis. Following penicillin treatment, the heavy proteinuria and skin lesions rapidly were resolved within 2 weeks. For secondary MN with atypical clinical manifestations, particularly on a non-preferred age young patient, it may be necessary to conduct serological screening for syphilis, even in countries with low prevalence.

關鍵字

fluorescent treponemal antibody absorption (FTA-ABS) ； membranous nephropathy ； proteinuria ； rapid plasma regain (RPR)