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Review
. 2020 Jan-Dec:8:2324709620967212.
doi: 10.1177/2324709620967212.

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

Faisal Inayat  1 , Talal Almas  2 , Syed Rizwan A Bokhari  3 , Aun Muhammad  1 , Moh'd A Sharshir  4
Affiliations
Review

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

Faisal Inayat et al. J Investig Med High Impact Case Rep. 2020 Jan-Dec.

Abstract

Membranous glomerulonephritis is one of the common causes of nephrotic syndrome in the adult population. It is idiopathic in the majority of patients, but the secondary forms can be seen in the setting of autoimmune disease, cancer, infection, and following exposure to certain medications. However, subclinical syphilis-related membranous nephropathy remains a particularly rare clinicopathologic entity in modern times. In this article, we chronicle an interesting case of latent syphilis masquerading as membranous glomerulonephritis, which resolved with benzathine penicillin without requiring immunosuppressive treatment. We further supplement this paper with a concise review of the relevant literature that delineates the utility of appropriate antibiotic therapy in the management of luetic membranous nephropathy. Clinicians should remain cognizant of secondary syphilis while evaluating patients for possible glomerulonephritis or those presenting with proteinuria. Additionally, patients with hepatitis B, hepatitis C, and human immunodeficiency virus infections are not infrequently coinfected with Treponema pallidum. Therefore, a high index of suspicion for systemic manifestations of syphilis such as nephrotic syndrome is warranted in the setting of a coinfection. Prompt diagnosis and treatment of syphilis may result in resolution of proteinuria, without the need for standard immunosuppressive therapy commonly used in clinical practice.

Keywords: antibiotic treatment; membranous glomerulonephritis; nephrotic syndrome; proteinuria; secondary syphilis; therapeutic decision-making; unique presentation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The line graph demonstrates resolution of luetic membranous glomerulonephritis after intramuscular benzathine penicillin 2.4 million units weekly for 3 weeks. As shown by the single star, August 11, 2016, was when the initial dose of penicillin was administered. The serum creatinine and urine protein/creatinine (UPC) levels started to decline immediately after the first dose. On August 19, 2016, as marked by the double star, the second dose of penicillin was administered. The levels of serum creatinine and UPC continued to fall. Subsequently, as depicted by the triple star, the third dose of penicillin was instituted on August 27, 2016. Thereafter, it resulted in the sustained normalization of renal parameters to the baseline levels of the patient.
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