Dahmani O, Target N, Guy Jp, Belkhelfa S, Jeanvoine F Mermet, Servonnat J, Djellid J
Department of nephrology, CH Louis Jaillon Saint-Claude, 39206, France.
Cases J. 2010 Jan 13;3:23. doi: 10.1186/1757-1626-3-23.
Syphilis is a sexually transmitted disease, remaining under-estimated, under-recognized due to the variability of clinical presentation and ageing of the population with chronic comorbidities. Hence, some manifestations of the past are nowadays superimposed on the course of chronic diseases. Clinical suspicion should be guided by past medical history of contracting any other sexual disease in a heterosexual person or man who has sex with man.
We describe a rare case of tertiary syphilis in a hemodialyzed diabetic patient whom was career of chronic liver disease due to the evolution of chronic hepatitis B virus infection complicated by a hepatocellular carcinoma. Initial orientation in diagnosing this rare presentation of progressive painless lower limbs weakness was attributed to possible side effects of ongoing anti viral therapy including lamivudine and adefovir. We continued administering both drugs while patient notified a spectacular improvement under Ceftriaxone therapy introduced empirically for a possible chest infection. Routine ophthalmologic examination realized in a teaching hospital, scheduled without knowing the course of late infection showed the presence of a syphilitic uveitis.
This case emphasizes the need for a high index of clinical suspicion for syphilis before the occurrence of symptoms related to its end organ damage dominated by neurosyphilis form. Early diagnosis is the key to preventing significant morbidity and mortality and improving prognosis. However, in the setting of chronic diseases such as chronic kidney diseases either before setting up methods of renal replacement therapy or under immune-suppressive therapy; clinical presentation might resemble any disease, delaying the certitude of the diagnosis by prescribing a rapid plasma reagin.
梅毒是一种性传播疾病，由于临床表现的多样性以及患有慢性合并症的人群老龄化，其一直未得到充分重视和认识。因此，过去梅毒的一些表现如今叠加在慢性疾病的病程中。临床怀疑应基于异性恋者或男同性恋者曾感染其他性传播疾病的既往病史。
我们描述了一例血液透析的糖尿病患者发生三期梅毒的罕见病例，该患者因慢性乙型肝炎病毒感染进展并发肝细胞癌而患有慢性肝病。诊断这种罕见的进行性无痛性下肢无力表现时，最初的诊断方向归因于正在进行的包括拉米夫定和阿德福韦在内的抗病毒治疗可能产生的副作用。我们继续使用这两种药物，而患者在经验性使用头孢曲松治疗可能的胸部感染时症状显著改善。在一家教学医院进行的常规眼科检查（在不知道晚期感染病程的情况下安排）显示存在梅毒性葡萄膜炎。
该病例强调在出现以神经梅毒为主的终末器官损害相关症状之前，对梅毒要有高度的临床怀疑指数。早期诊断是预防严重发病和死亡以及改善预后的关键。然而，在慢性疾病如慢性肾脏病的情况下，无论是在建立肾脏替代治疗方法之前还是在免疫抑制治疗期间，临床表现可能类似于任何疾病，通过开具快速血浆反应素检测会延迟诊断的确立。
