Department of Nephrology, St-Mary's Hospital, McGill University, 3830 av Lacombe, Qc, H3T 1M5, Montreal, Canada.
Department of Pathology, McGill University, Montreal, QC, Canada.
BMC Nephrol. 2021 May 25;22(1):196. doi: 10.1186/s12882-021-02404-z.
Syphilis is a multisystemic infection that causes a wide variety of symptoms and thus has been dubbed one of the great medical mimickers. Due to recent global re-emergence of syphilis, it has become important to recognize its various presentations. Relative to the kidney, syphilitic infections generally present themselves with nephrotic range proteinuria, and are most often associated with pathological features of a membranous glomerulonephritis with subepithelial immune complex deposition. However, other rare renal presentations have been reported. One of these includes a rapidly progressive glomerulonephritis picture. All described cases have been successfully resolved with the treatment of the underlying syphilis infection.
The patient was an elderly woman of Caribbean descent who presented with lower extremity weakness, anasarca and proteinuria, hematuria with progressive renal failure. On kidney biopsy, she was found to have a pauci-immune crescentic glomerulonephritis pattern and a concomitant acute tubulointerstitial nephritis. She had a positive Treponema pallidum particle agglutination test and a negative syphilis rapid plasma reagin test with clinical evidence of polyneuropathy suggestive chronic syphilis infection.
It is important in the context of pauci-immune crescentic glomerulonephritis to explore all differential diagnoses. Given the positive syphilis serologies, clinical context and presence of tubulointerstitial nephritis, she was determined to have syphilitic glomerulonephritis that resolved with a course of both penicillin and steroids.
梅毒是一种全身性感染，可引起多种症状，因此被称为最伟大的医学模拟疾病之一。由于梅毒在全球范围内的再次出现，认识其各种表现形式变得非常重要。相对于肾脏，梅毒感染通常表现为肾病范围蛋白尿，并且最常与膜性肾小球肾炎的病理特征相关，伴有上皮下免疫复合物沉积。然而，已经报道了其他一些罕见的肾脏表现。其中之一包括快速进行性肾小球肾炎。所有描述的病例都通过治疗潜在的梅毒感染得到了成功解决。
患者是一位加勒比裔老年女性，表现为下肢无力、全身性水肿和蛋白尿、血尿伴进行性肾衰竭。肾脏活检发现她患有少免疫性新月体肾小球肾炎和急性肾小管间质性肾炎。她的梅毒螺旋体颗粒凝集试验阳性，梅毒快速血浆反应素试验阴性，伴有提示慢性梅毒感染的多发性神经病的临床证据。
在少免疫性新月体肾小球肾炎的背景下，探索所有鉴别诊断非常重要。鉴于梅毒血清学阳性、临床背景和肾小管间质性肾炎的存在，她被诊断为梅毒肾小球肾炎，经青霉素和类固醇治疗后得到缓解。
