Yang Chun-Chi, Chen Jui-Yi, Chang Hsuan-Yuan, Sheu Ming-Jen, Feng I-Che, Wang Su-Hung, Kuo Hsing-Tao
Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Case Rep Gastroenterol. 2024 Mar 18;18(1):136-143. doi: 10.1159/000537922. eCollection 2024 Jan-Dec.
Syphilis, an ancient sexually transmitted disease, is recognized as a systemic infection disease manifesting with diverse symptoms and variations. Secondary syphilis characterized by systemic symptoms resulted from hematogenous and lymphatic dissemination of the infection, may include manifestations such as hepatitis and nephrotic syndrome. However, the simultaneous occurrence of hepatitis and nephrotic syndrome in secondary syphilis is rare.
A young man presented with fatigue, abnormal liver function tests, and hyperbilirubinemia and had history of men who have sex with men (MSM). Serological tests confirmed the diagnosis of secondary syphilis, and kidney biopsy indicated membranous nephritis. After antibiotic treatment, the patient experienced resolution of proteinuria, and liver enzyme levels returned to normal.
Syphilis should be considered in the differential diagnosis of simultaneous liver and kidney dysfunction, particularly in patients engaging in high-risk sexual behavior. This case highlights the importance of considering syphilis in young patients with MSM and presenting with unexplained nephrotic syndrome and liver abnormalities.
梅毒是一种古老的性传播疾病，被认为是一种表现出多种症状和变异的全身性感染疾病。二期梅毒以全身症状为特征，是由感染的血行和淋巴播散引起的，可能包括肝炎和肾病综合征等表现。然而，二期梅毒中同时出现肝炎和肾病综合征的情况较为罕见。
一名年轻男性出现疲劳、肝功能检查异常和高胆红素血症，有男男性行为史。血清学检查确诊为二期梅毒，肾活检显示为膜性肾炎。抗生素治疗后，患者蛋白尿消失，肝酶水平恢复正常。
在鉴别诊断同时出现肝肾功异常时应考虑梅毒，特别是在有高危性行为的患者中。本病例强调了在患有肾病综合征和肝脏异常且病因不明的男男性行为年轻患者中考虑梅毒的重要性。
