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Case Reports
. 2024 Apr;13(2):86-92.
doi: 10.1007/s13730-023-00803-9. Epub 2023 Jun 23.

Nephrotic "full-house" glomerulonephritis successfully treated with antibiotics alone in secondary syphilis: a case report

Misaki Taniguchi  1 , Tomomi Endo  2 , Mea Asou  1 , Tatsuo Tsukamoto  1
Affiliations
Case Reports

Nephrotic "full-house" glomerulonephritis successfully treated with antibiotics alone in secondary syphilis: a case report

Misaki Taniguchi et al. CEN Case Rep. 2024 Apr.

Abstract

A Japanese female in her twenties developed general edema with heavy proteinuria, and was referred to our hospital. She exhibited the common clinical manifestation of idiopathic nephrotic syndrome with massive proteinuria (20.37 g/day), hypoalbuminemia (1.8 g/dL), and hypercholesterolemia (300 mg/dL). Routine admission tests were positive results for both the rapid plasma reagin latex agglutination test for syphilis (RPR) and the Treponema pallidum particle agglutination assay (TPHA). As such, we made her a diagnosis of nephrotic syndrome due to secondary syphilis. Renal biopsy revealed "full-house" nephropathy. Following the commencement of penicillin treatment, she developed skin rash, indicating the Jarisch-Herxheimer reaction (JHR). Her nephrotic syndrome responded rapidly and she achieved complete remission with antibiotic therapy alone after 4 weeks. In light of the increasing incidence of syphilis in Japan, clinicians should consider syphilis as a reversible cause of nephrotic syndrome.

Keywords: Full-house nephropathy; Jarisch-Herxheimer reaction; Nephrotic syndrome; Secondary syphilis.

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Conflict of interest statement

The authors have declared that no conflicts of interest exist.

Figures

Fig. 1
Fig. 1
Clinical course. After initiation of antibiotic therapy, her urinary protein decreased dramatically up to 0.25 g/day by day 7. She has remained in complete remission since the end of antimicrobial therapy
Fig. 2
Fig. 2
Histological findings of kidney biopsy. The light microscopic image showed only a slight increase in the mesangial matrix with cell proliferation without apparent basement membrane lesions. Immunofluorescent microscopy showed granular deposits of IgG, C1q, and C3c along the glomerular basement membrane and staining of IgG, IgA, IgM, C1q, C3c, and C4c in the mesangial area (full-house pattern). Electron microscopy confirmed subepithelial electron dense deposits and a subtle mesangial deposit
Fig. 3
Fig. 3
Additional immunohistochemical and immunofluorescence staining. A CD45, B CD68, C IgG subclasses, D PLA2R, E NELL1, F THSD7A. Both CD68 (macrophage) and CD45 (leukocyte common antigen) were negative in glomeruli (A, B). IgG subclass staining was positive in IgG1 and IgG3 (C). Anti-PLA2R antibody was negative (D). Immunohistochemical staining of NELL1 and THSD7A showed also negative (E, F)
See this image and copyright information in PMC

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References

    1. Hook EW., 3rd Syphilis Lancet. 2017;389(10078):1550–1557. doi: 10.1016/S0140-6736(16)32411-4. - DOI - PubMed
    1. Peeling RW, Mabey D, Kamb ML, Chen XS, Radolf JD, Benzaken AS. Syphilis Nat Rev Dis Primers. 2017;3:170–173. - PMC - PubMed
    1. Takahashi T, Arima Y, Yamagishi T, Nishiki S, Kanai M, Ishikane M, et al. Rapid increase in reports of syphilis associated with men who have sex with women and women who have sex with men, Japan, 2012 to 2016. Sex Transm Dis. 2018;45(3):139–143. doi: 10.1097/OLQ.0000000000000768. - DOI - PMC - PubMed
    1. Infectious Disease Surveilance Center and Department of Bacteriology 1. National Institute of infectious disease. Notification Trends among Syphilis Cases in Japan. 2023. https://www.niid.go.jp/niid/images/epi/syphilis/2022q4/syphilis2022q4.pdf
    1. Nishiki S, Arima Y, Kanai M, Shimuta K, Nakayama SI, Ohnishi M. Epidemiology, molecular strain types, and macrolide resistance of Treponema pallidum in Japan, 2017–2018. J Infect Chemother. 2020;26(10):1042–1047. doi: 10.1016/j.jiac.2020.05.022. - DOI - PubMed

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