PDF(Pubmed)
Abstract：
Syphilis is an often-overlooked diagnosis and without timely diagnosis and treatment, can have serious repercussions. Although its prevalence had decreased with the introduction of penicillin, it has had a resurgence over the years. Discerning the proper patient population to test for syphilis should be led by a patient\'s risk factors. Here, we present a patient diagnosed with secondary syphilis, with initial concern for a possible concomitant lupus diagnosis. He initially presented with visual symptoms and optic nerve inflammation, along with a positive antinuclear antibody (ANA). Due to an unprotected sexual encounter, there was suspicion for a sexually transmitted infection. Testing revealed reactive rapid plasma reagin (RPR) (≥1:256 titer) and reactive treponemal antibody, consistent with active syphilis. He was immediately started on intravenous Penicillin G. Lumbar puncture was consistent with a reactive venereal disease research laboratory test (VDRL). Urinalysis revealed nephrotic range proteinuria, which along with the positive ANA, prompted renal biopsy. This showed membranous nephropathy with full house staining, which is seen primarily in lupus nephritis and further confounded the diagnosis. He completed a two-week course of penicillin and steroids inpatient with clinical improvement. On follow up, his RPR improved (≥1:64 titer), and lumbar puncture showed a non-reactive VDRL. Due to the resolution of proteinuria, decrease of the ANA titer and no further positive testing or symptoms convincing for a concomitant rheumatologic disorder, the presence of lupus was collectively determined to be of low concern. and the sole diagnosis of secondary syphilis was made.
摘要：
梅毒是一种经常被忽视的诊断，没有及时的诊断和治疗，会产生严重的影响。尽管随着青霉素的引入，其患病率有所下降，多年来它已经复苏。识别正确的患者人群进行梅毒检测应以患者的危险因素为主导。这里,我们介绍了一个诊断为二期梅毒的病人,最初担心可能伴随的狼疮诊断。他最初表现为视觉症状和视神经发炎，抗核抗体（ANA）阳性。由于没有保护的性接触，怀疑是性传播感染。检测显示反应性快速血浆反应素（RPR）（滴度≥1：256）和反应性密螺旋体抗体，与活动性梅毒一致。他立即开始静脉注射青霉素G。腰椎穿刺符合反应性性病研究实验室测试（VDRL）。尿液分析显示肾病范围蛋白尿，连同积极的ANA，提示肾活检。这显示膜性肾病全屋染色，主要见于狼疮性肾炎，进一步混淆了诊断。他完成了为期两周的青霉素和类固醇住院患者的临床改善。在后续行动中，他的RPR改善（滴度≥1:64），腰椎穿刺显示无反应性VDRL。由于蛋白尿的解决，ANA滴度下降，没有进一步的阳性测试或症状令人信服的伴随风湿病，狼疮的存在被集体确定为低关注。并做出了二期梅毒的唯一诊断。
