Syphilis as a rare cause of nephrotic syndrome in Paediatrics: a case report

Abstract

Syphilis is a rare but recognised cause of renal involvement, including nephrotic syndrome. Membranous nephropathy is the glomerulopathy most commonly associated with Treponema pallidum infection, typically mediated by immune complexes containing bacterial antigens. We report the case of a previously healthy 15-year-old female who presented with nephrotic syndrome, characterised by periorbital and lower limb oedema, accompanied by nonspecific respiratory symptoms. Laboratory evaluation revealed nephrotic-range proteinuria, hypoalbuminaemia, and preserved renal function. As part of the aetiological work-up, serological testing for syphilis (VDRL and TPHA) was positive. A kidney biopsy confirmed membranous nephropathy. The patient was treated with benzathine penicillin G and prednisolone, resulting in resolution of oedema, proteinuria and hypoalbuminemia. This case underscores the importance of taking a thorough sexual history and screening for sexually transmitted infections in adolescents presenting with nephrotic syndrome. Syphilis should be considered a relevant differential diagnosis, particularly given the rising prevalence of sexually transmitted diseases among young people.