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Not all that is ‘full house’ is systemic lupus erythematosus: a case of membranous nephropathy due to syphilis infection
  1. Moira Marie Scaperotti1,
  2. DongHyang Kwon2,
  3. Bhaskar V Kallakury2 and
  4. Virginia Steen1
  1. 1Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA
  2. 2Pathology, MedStar Georgetown University Hospital, Washington, DC, USA
  1. Correspondence to Dr Moira Marie Scaperotti; mscaperotti{at}gmail.com

Abstract

We describe an unusual case of membranous nephropathy precipitated by syphilis infection in a patient without systemic lupus erythematosus (SLE). A previously healthy 20-year-old man presented with leg and facial swelling. Laboratory investigation revealed nephrotic range proteinuria, acute kidney injury, hypocomplementaemia and a highly positive rapid plasma reagin. Kidney biopsy showed membranous nephropathy with ‘full-house’ immunofluorescence (IgG, IgA, IgM, C1q and C3), mimicking lupus nephritis class Vb. However, the patient had no features of SLE and had negative antinuclear and anti-double-stranded DNA antibodies. He was treated with high-dose methylprednisolone and mycophenolate mofetil for lupus nephritis and with penicillin for syphilis. After 2 months of therapy, his proteinuria resolved, and his renal function and C4 level normalised. This case illustrates that syphilis infection can be a mimicker of lupus nephritis. A literature review suggests that ful-house nephropathy may occur independently of lupus nephritis and may or may not develop into SLE.

  • acute renal failure
  • nephrotic syndrome
  • proteinurea
  • systemic lupus erythematosus
  • syphilis

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Footnotes

  • Contributors MS and DHK wrote the manuscript. VS and BK edited the manuscript. All authors approve of the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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