Gastrointestinal bleeding caused by syphilis: A case report

BACKGROUND Syphilis is a chronic,classic sexually transmitted disease caused by Treponema pallidum,which can invade almost all organs of the body and produce various symptoms and signs.Although there are some cases of colorectal bleeding caused by syphilis,small intestinal bleeding caused by syphilis is still rare.CASE SUMMARY A 58-year-old man had experienced recurrent abdominal pain and melena for 3 years.Repeated gastroenteroscopy and computed tomography angiography examinations failed to find bleeding lesions.During the same admission,multiple intestinal ulcers were found by capsule endoscopy,and syphilis was also diagnosed.With a history of atrial fibrillation and chronic pancreatitis,he had undergone mitral valve replacement and tricuspid valvuloplasty for valvular heart disease.After anti-syphilis treatment,the melena and abdominal pain disappeared and his hemoglobin gradually increased.It is considered that gastrointestinal bleeding,chronic pancreatitis,atrial fibrillation,and heart valvular disease may have been caused by syphilis.CONCLUSION This case report found that syphilis can mimic systemic disease and cause intestinal bleeding.In addition,treatment of the disease requires both sexual partners to be treated.Finally,although syphilis is easy to treat,it is more important to consider that bleeding could be caused by syphilis.

Advances in the treatment of IgA nephropathy with biological agents

Immunoglobulin A nephropathy(IgAN)is the most common primary glomerular disease,and the“four-hit”theory represents its currently accepted pathogenic mechanism.Mucosal immunity triggered by infections in the respiratory tract,intestines,or other areas leads to antigen presentation,T cell stimulation,B cell maturation,and the production of IgA-producing plasma cells.The proteins B-lymphocyte stimulator(BLyS)and a proliferation-inducing ligand(APRIL)are involved in this process,and alternative complement and lectin pathway activation are also part of the pathogenic mechanism.Kidney Disease Improving Global Outcomes guidelines indicate that a specific effective treatment for IgAN is lacking,with renin-angiotensin-aldosterone system inhibitors being the primary therapy.Recent research shows that biological agents can significantly reduce proteinuria,stabilize the estimated glomerular filtration rate,and reverse some pathological changes,such as endocapillary proliferation and crescent formation.There are four main categories of biological agents used to treat IgA nephropathy,specifically anti-CD20 monoclonal antibodies,anti-BLyS or APRIL monoclonal antibodies,monoclonal antibodies targeting both BLyS and APRIL(telitacicept and atacicept),and monoclonal antibodies inhibiting complement system activation(narsoplimab and eculizumab).However,further research on the dosages,treatment duration,long-term efficacy,and safety of these biological agents is required.