SHM Converge Scientific Abstract ePoster Gallery-The Great Masquerador Strikes Again! Acute Nephrotic Syndrome and Otosyphilis

Pdf Summary

This case report describes a 30-year-old man with acute left-sided hearing loss, vertigo, rash, fevers, malaise, edema, shortness of breath, and chest pain. On exam, he had macular lesions on the palms and soles, palm desquamation, and generalized anasarca. Testing revealed strongly positive syphilis serologies (RPR 1:128 and positive Treponema antibody), elevated liver enzymes, high LDL, and nephrotic-range proteinuria of 4.8 g/day. HIV, Lyme disease, hepatitis, and viral respiratory testing were negative. CSF studies showed lymphocytic pleocytosis and elevated protein, but CSF VDRL and FTA were nonreactive.<br /><br />He was treated with continuous intravenous penicillin for presumed otosyphilis, along with aspirin, lisinopril, and furosemide for nephrotic syndrome, and he improved clinically. The authors note that otosyphilis is treated like neurosyphilis and can cause irreversible hearing loss if missed. Syphilis is a well-known “great masquerader,” and although nephrotic syndrome is usually idiopathic, it can rarely be secondary to infections such as syphilis. The mechanism is thought to involve immune complex formation and membranous nephropathy.<br /><br />The report emphasizes that early recognition of syphilis as an underlying cause of nephrotic syndrome can prevent unnecessary testing and avoid inappropriate immunosuppressive treatment. It may also reduce the risk of relapse and permanent hearing loss. The authors state that this may be the first reported case of acute nephrotic syndrome associated with otosyphilis.

Asset Subtitle

Vijairam Selvaraj

Meta Tag

Author List Denise Fernandes, Kwame Dapaah-Afriyie, Vijairam Selvaraj

Category Clinical Vignettes

Concept Syphilis

Concept Secondary Nephrotic Syndrome

Concept Otic syphilis

Concept Neurosyphilis

Concept Intravenous Penicillin G

Distinguished Non-Finalist

Presenter Organization Miriam Hospital

Presenting Author Vijairam Selvaraj

Track Adult

Keywords

otosyphilis

syphilis

nephrotic syndrome

hearing loss

penicillin

immune complex

membranous nephropathy

proteinuria

neurosyphilis

rash

Syphilis

Secondary Nephrotic Syndrome

Otic syphilis

Neurosyphilis

Intravenous Penicillin G