Atypical presentation of syphilis: Rapidly progressive glomerulonephritis

Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. With the recent worldwide resurgence of syphilis, it is imperative to recognize various presentations of this great imitator. Renal syphilis is rare and most commonly present as nephrotic range proteinuria associated with pathological features of membranous glomerulonephritis. Rapidly progressive glomerulonephritis (RPGN) is a rare and atypical form of renal syphilis. A 50-year-old Ethiopian woman presented with periorbital swelling, hematuria, proteinuria, and rapidly progressive renal failure. Rapid plasma reagin and confirmatory Treponema pallidum hemagglutination (TPHA) tests were reactive. Treatment with a weekly Benzathine penicillin for 3 weeks resulted in a rapid return of renal function to baseline, with the increasing rate of new syphilis, clinicians should be mindful of the various renal manifestation of syphilis. This case highlights the significance of considering syphilis as a reversible cause in any patient presenting with a clinical feature suggestive of RPGN.