Dr Laura Bywater1, Dr Karen Chee, Dr Parthasarathy Shanmugasundaram, Dr Salim Maher, Dr Robert Stevens
1The Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, Australia, 2St George Hospital, South Eastern Sydney Local Health District, Sydney, Australia
Biography:
Bio to come
Background:
Syphilis is re-emerging in Australia, with notification rates rising from 6.6 to 24.6 per 100,000 between 2013 and 2023, particularly among young adults and Aboriginal and Torres Strait Islander populations. While classically associated with dermatologic and neurologic features, syphilis can also cause glomerulonephritis usually via immune complex deposition, with patterns including membranous nephropathy, membranoproliferative and crescentic glomerulonephritis. Co-infection with hepatitis B virus (HBV), a known cause of secondary glomerular disease, may further complicate clinical presentation.
Case Report:
A 20-year-old male presented with a one-week history of lower limb oedema. Investigations revealed nephrotic-range proteinuria (urine protein: creatinine ratio 694mg/mmol), elevated transaminases (ALT 1549 U/L; AST 1407 U/L), and high HBV DNA (9 log IU/mL). Serology confirmed active syphilis. Renal biopsy demonstrated membranous nephropathy with granular IgG, C3, C1q deposition. Liver biopsy showed active hepatitis B (METAVIR A3, F0) with positive core and surface antigen staining. The patient developed a Jarisch-Herxheimer reaction following the first dose of benzylpenicillin. Supportive care, antibiotics, and antiviral therapy led to rapid improvement: proteinuria halved, liver function improved, and HBV DNA declined to 5.99 log IU/mL within five days.
Conclusion:
This case highlights the importance of recognising syphilis-associated glomerulonephritis, particularly amid rising national incidence. Co-infection with HBV may enhance immune-mediated renal injury. Early recognition, biopsy confirmation, and targeted therapy are key to optimal outcomes. Clinicians should consider syphilis in the differential diagnosis of glomerular disease with systemic features, especially in high-risk populations.