Nephrotic Syndrome: Beyond Common Causes

We report the case of a 38-year-old Caucasian man with well-controlled HIV on antiretroviral therapy who developed nephrotic syndrome. The patient presented with a maculopapular rash, lymphadenopathy, oral lesions, nasal congestion and bilateral pitting oedema. Laboratory tests revealed hypoalbuminemia, nephrotic range proteinuria and abnormal liver function. Further investigations confirmed secondary syphilis with positive Treponema pallidum serology. Kidney biopsy showed membranous nephropathy. Treatment with Benzathine benzylpenicillin resulted in a rapid resolution of nephrotic syndrome, improved liver function and normalisation of serum albumin levels. This case highlights the rare but recognised link between syphilis and nephrotic syndrome, emphasising the importance of prompt diagnosis and antibiotic treatment to prevent the need for more aggressive treatments. Syphilis can cause a variety of systemic manifestations, and co-infection with HIV is common due to their shared transmission route. Healthcare providers must remain vigilant in considering syphilis as a potential cause of nephrotic syndrome in HIV-positive patients, particularly when other clinical and laboratory features suggest its presence.