以发热、皮疹、全身淋巴结肿大为首发表现的梅毒相关膜增生性肾小球肾炎1例

Syphilis-related membranous proliferative glomerulonephritis with fever, skin rash and generalized lymph node enlargement as the initial manifestations: a case report

该文报告1例以发热、皮疹、全身淋巴结肿大伴血三系下降为首发表现的梅毒相关膜增生性肾小球肾炎病例, 为临床诊治提供参考。患者因发热、皮疹、全身淋巴结肿大伴血三系下降入院, 经多种检查排除淋巴瘤等疾病, 后出现水肿伴蛋白尿, 查梅毒甲苯胺红不加热血清试验(TRUST)1∶4(+), 血清梅毒特异性抗体(TPPA)>1∶160(+), 肾活检病理结果提示膜增生性肾小球肾炎, 考虑梅毒肾病, 予青霉素驱梅治疗后病情好转。肾脏病理表现为膜增生性肾小球肾炎的梅毒肾病罕见, 应引起重视, 驱梅治疗预后良好。

A case of syphilis-related membranous proliferative glomerulonephritis is reported,presenting with fever,rash,generalized lymphadenopathy,and peripheral hypocytosis as the initial symptoms.The patient was admitted to the hospital and underwent various examinations to rule out lymphoma and other diseases.Subsequently,the patient developed edema with proteinuria.The toluidine red unheated serum test(TRUST)was 1∶4(+)and the treponema pallidum particle agglutination(TPPA)test was>1∶160(+).The pathological results of renal biopsy revealed membranous proliferative glomerulonephritis.The diagnosis of the patient was considered syphilitic nephropathy.Treatment with penicillin resulted in improvement of the condition.The coexistence of syphilitic nephropathy and membranous proliferative glomerulonephritis is rare and should be given careful attention in clinical practice.Antisyphilitic treatment improves the prognosis.