Zhou Zhang1, Aviv Hever2, Nitin Bhasin3, Dean A Kujubu4. 1. Pulmonary and Critical Care Fellow at the Cedars-Sinai Medical Center and at the Los Angeles Medical Center in CA. zzhan001@gmail.com. 2. Surgical and Renal Pathologist in the Department of Pathology at the Los Angeles Medical Center in CA. aviv.hever@kp.org. 3. Staff Nephrologist at California Kidney Specialists in Monrovia, CA. bhnitin7@gmail.com. 4. Nephrology Fellowship Program Director at the Los Angeles Medical Center in CA. dean.a.kujubu@kp.org.
Abstract
INTRODUCTION: We present a case of membranous nephropathy associated with a secondary syphilis infection in a patient with HIV. CASE PRESENTATION: A 37-year-old white man with HIV who was receiving highly active antiretroviral therapy presented to the Emergency Department with 6 weeks of rectal pain. He had a CD3-CD4 count of 656 cells/mm3 and an undetectable viral load. On admission, he was found to have an anal ulcer, a serum creatinine of 1.4 mg/dL (baseline 0.7 to 1.0 mg/dL), elevated transaminases, positive rapid plasmin reagin, and a urine protein/creatinine ratio revealing nephrotic-range proteinuria. Renal biopsy demonstrated membranous nephropathy with features suggestive of a secondary cause. Our patient was treated with penicillin for secondary syphilis, with normalization of renal function, resolution of the nephrotic syndrome, and improvement of his elevated transaminases. DISCUSSION: This case is a reminder that patients with HIV are not infrequently coinfected with Treponema pallidum and that secondary syphilis can have systemic manifestations, including elevated transaminases and nephrotic syndrome. Prompt diagnosis and treatment will result in resolution of these problems.
INTRODUCTION: We present a case of membranous nephropathy associated with a secondary syphilis infection in a patient with HIV. CASE PRESENTATION: A 37-year-old white man with HIV who was receiving highly active antiretroviral therapy presented to the Emergency Department with 6 weeks of rectal pain. He had a CD3-CD4 count of 656 cells/mm3 and an undetectable viral load. On admission, he was found to have an anal ulcer, a serum creatinine of 1.4 mg/dL (baseline 0.7 to 1.0 mg/dL), elevated transaminases, positive rapid plasmin reagin, and a urine protein/creatinine ratio revealing nephrotic-range proteinuria. Renal biopsy demonstrated membranous nephropathy with features suggestive of a secondary cause. Our patient was treated with penicillin for secondary syphilis, with normalization of renal function, resolution of the nephrotic syndrome, and improvement of his elevated transaminases. DISCUSSION: This case is a reminder that patients with HIV are not infrequently coinfected with Treponema pallidum and that secondary syphilis can have systemic manifestations, including elevated transaminases and nephrotic syndrome. Prompt diagnosis and treatment will result in resolution of these problems.
Authors: A Alarcón-Zurita; A Salas; E Antón; A Morey; M A Munar; P Losada; J Martinez Journal: Nephrol Dial Transplant Date: 2000-07 Impact factor: 5.992
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Authors: Aikaterini Nikolopoulou; Catarina Teixeira; H Terry Cook; Candice Roufosse; Thomas H D Cairns; Jeremy B Levy; Charles D Pusey; Megan E Griffith Journal: Clin Kidney J Date: 2020-04-15