Immunology, North Bristol NHS Trust, Southmead Road, Bristol, BS10 5NB, UK.
BMC Infect Dis. 2020 Sep 21;20(1):692. doi: 10.1186/s12879-020-05418-4.
Syphilis has seen an increased incidence in recent years and can have serious and irreversible consequences if left un-diagnosed and untreated. This case report describes a presentation of syphilis and acute kidney injury - a scenario sparsely described in existing literature.
This 43-year old Man who has Sex with Men (MSM) presented to the emergency department with a 3-week history of vomiting and headaches, progressing to include pyrexia. These symptoms started following his return from a 2-week cruise in Central America throughout which he had been well. He had a background of well-controlled human immunodeficiency virus (HIV). On admission he had an Acute Kidney Injury (AKI) stage 3, without hydronephrosis, presumed to be pre-renal. Leptospirosis, the main differential, was negative serologically. 'Pyrexia of unknown origin' testing was performed, and cefuroxime commenced. Later in the admission, syphilis testing indicated an acute infection and he completed a full treatment course of benzylpenicillin. This, alongside intravenous fluids, resulted in symptom and renal resolution in 9 days and restoration of renal function.
Renal complications in syphilis are rare, furthermore the majority of those documented occur in latent syphilis and are irreversible. There are limited numbers of other documented cases of AKI in acute syphilis, which like the gentleman in this case were reversible and did not lead to permanent kidney damage. This case adds to the knowledge base of AKI in initial presentation of syphilis. It also demonstrates not only the importance of taking a sexual history in patients with new infective symptoms but that testing for syphilis in at-risk groups regardless of history should be performed given its rising incidence. These considerations by physicians can lead to prompt diagnosis and management of syphilis and improve patient care and long-term outcomes.
近年来梅毒的发病率有所上升，如果未经诊断和治疗，梅毒可能会导致严重且不可逆转的后果。本病例报告描述了梅毒和急性肾损伤的表现，这种情况在现有文献中描述较少。
这位 43 岁的男同性恋者（MSM）因呕吐和头痛病史 3 周，伴发热，来急诊就诊。这些症状始于他从中美洲为期 2 周的游轮旅行归来后，在旅行期间他身体状况良好。他有人类免疫缺陷病毒（HIV）得到良好控制的病史。入院时，他患有急性肾损伤（AKI）3 期，无肾盂积水，推测为肾前性。血清学检测阴性排除了钩端螺旋体病，作为主要鉴别诊断。进行了“原因不明发热”检测，并开始使用头孢呋辛。在住院期间，梅毒检测提示急性感染，他完成了完整的苄星青霉素治疗疗程。这与静脉补液一起，在 9 天内缓解了症状和肾脏问题，并恢复了肾功能。
梅毒的肾脏并发症罕见，而且大多数有记录的并发症发生在潜伏梅毒，且是不可逆转的。急性梅毒并发 AKI 的其他记录病例数量有限，与本例患者一样，这些病例是可逆的，并未导致永久性肾脏损害。本病例增加了 AKI 在梅毒初始表现中的知识基础。它还表明，不仅在有新发感染症状的患者中进行性病史采集很重要，而且鉴于梅毒发病率上升，无论病史如何，都应在高危人群中进行梅毒检测。医生的这些考虑可以促进梅毒的快速诊断和管理，改善患者的护理和长期预后。
