SHM Converge Scientific Abstract ePoster Gallery-The Great Mimicker: Just Another Face of Syphilis

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A 36-year-old woman with asthma presented with three weeks of worsening anasarca, malaise, headache, and subjective cognitive decline after multiple prior visits and empiric treatment for a presumed UTI. On admission, she had acute kidney injury and severe hypoalbuminemia, with creatinine 1.28 mg/dL, BUN 14 mg/dL, and albumin 1.5 g/dL. Urine testing showed significant proteinuria, but her broader workup for common causes of nephrotic syndrome was unrevealing, including tests for hepatitis, HIV, ANA, anti-PLA2R IgG, and complement levels.<br /><br />Further evaluation revealed a positive treponemal antibody test with an RPR titer of 1:16. Lumbar puncture was not consistent with neurosyphilis. An image-guided kidney biopsy showed membranous nephropathy with a “full house” immunofluorescence pattern, supporting secondary membranous nephropathy due to syphilis.<br /><br />The patient was treated with intramuscular penicillin G, diuretics, and low-dose losartan. At two-week follow-up, she had marked clinical and laboratory improvement, including creatinine 0.84 mg/dL, albumin 3.6 g/dL, and urine protein/creatinine ratio of 67 mg/g. She was advised to continue losartan until nephrology follow-up.<br /><br />This case highlights syphilis as an uncommon but important cause of secondary membranous nephropathy. Although primary membranous nephropathy is more common, secondary forms can result from infections, medications, and autoimmune disease. Syphilis can involve the kidneys in multiple ways and should be considered in patients with unexplained nephrotic features, especially given the increasing incidence of syphilis and its often reversible renal manifestations when appropriately treated.

Asset Subtitle

Yahor Sukharutski

Meta Tag

Author List Christopher R. Force, Hala Hassanain, Helene DiGregorio, Yahor Sukharutski

Category Clinical Vignettes

Concept Syphilis

Concept Membranous Nephropathy

Concept Nephrotic Syndrome

Concept Proteinuria

Concept Kidney Biopsy

Distinguished Non-Finalist

Presenter Organization Houston Methodist Hospital

Presenting Author Yahor Sukharutski

Track Adult

Keywords

syphilis

secondary membranous nephropathy

nephrotic syndrome

proteinuria

anasarca

acute kidney injury

hypoalbuminemia

treponemal antibody

RPR titer

kidney biopsy

Syphilis

Membranous Nephropathy

Nephrotic Syndrome

Proteinuria

Kidney Biopsy