一名艾滋病毒患者出现与膜性肾病和急性肝炎相关的二期梅毒：病例报告
Secondary Syphilis Associated with Membranous Nephropathy and Acute Hepatitis in a Patient with HIV: A Case Report.
作者信息
Zhang Zhou, Hever Aviv, Bhasin Nitin, Kujubu Dean A
机构信息
Pulmonary and Critical Care Fellow at the Cedars-Sinai Medical Center and at the Los Angeles Medical Center in CA.
Surgical and Renal Pathologist in the Department of Pathology at the Los Angeles Medical Center in CA.
出版信息
Perm J. 2018;22:17-062. doi: 10.7812/TPP/17-062.
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/mm 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.
引言
我们报告一例感染人类免疫缺陷病毒（HIV）的患者，其患膜性肾病并伴有二期梅毒感染。
病例介绍
一名37岁接受高效抗逆转录病毒治疗的HIV感染白人男性因直肠疼痛6周就诊于急诊科。他的CD3⁺CD4⁺细胞计数为656个/立方毫米，病毒载量检测不到。入院时，发现他有肛门溃疡，血清肌酐为1.4毫克/分升（基线值为0.7至1.0毫克/分升），转氨酶升高，快速血浆反应素阳性，尿蛋白/肌酐比值显示为肾病范围蛋白尿。肾活检显示为膜性肾病，具有提示继发性病因的特征。我们的患者接受了青霉素治疗二期梅毒，肾功能恢复正常，肾病综合征缓解，转氨酶升高情况改善。
讨论
该病例提醒我们，HIV感染患者常合并苍白密螺旋体感染，二期梅毒可出现全身表现，包括转氨酶升高和肾病综合征。及时诊断和治疗可解决这些问题。
Zotero 插件