Subclinical acquired syphilis masquerading as membranous glomerulonephritis

Area of Science:

• Nephrology
• Infectious Diseases
• Immunology

Background:

• Membranous glomerulonephritis (MGN) is a common cause of nephrotic syndrome in adults, often idiopathic but sometimes secondary to autoimmune diseases, infections, or medications.
• Syphilis, a sexually transmitted infection, can lead to renal complications, including MGN, typically when untreated.
• Advances in medicine and awareness of STIs have reduced acquired syphilis cases, which usually present with characteristic symptoms like chancres and rash.

Observation:

• This report details a rare case of acquired syphilis that mimicked membranous glomerulonephritis.
• The patient presented with renal symptoms characteristic of MGN but lacked the typical clinical manifestations of syphilis.

Findings:

• The case demonstrates that acquired syphilis can present atypically, posing a diagnostic challenge.
• Immune complex deposition in the subepithelial space, characteristic of MGN, was observed, but the underlying cause was syphilis.

Implications:

• This case underscores the need for clinicians to consider syphilis in the differential diagnosis of membranous glomerulonephritis, especially in atypical presentations.
• Increased awareness and diagnostic vigilance for syphilis are crucial, even in the absence of classic symptoms, to ensure timely and appropriate treatment.
• Further research may elucidate the mechanisms by which syphilis induces membranous glomerulonephritis in such unusual presentations.