Ocular Manifestations and Full House Membranous Nephropathy as a Rare Presentation of Secondary Syphilis

Abstract

Introduction: Syphilis is known as the great mimicker with symptoms that overlap many diseases. Here we present a patient with secondary syphilis which manifested as ocular symptoms, as well as membranous nephropathy with a full house staining pattern. Case Description: Our patient was a 54-year-old male who presented with a rash, joint pain, foamy urine and vision changes. Initial work up found a positive ANA and other autoimmune labs, and he was admitted for concern of lupus papillitis. Labs and CSF were positive for syphilis, and he was found to have nephrotic range proteinuria. Renal biopsy showed membranous nephropathy with full house staining, which is seen primarily in lupus nephritis with only one case report noting its presentation in syphilis (Jaunin E, Kissling S, Rotman S, Waeber G, Halfon M. Syphilis and parvovirus B19 co-infection imitating a lupus nephropathy: A case report. Medicine (Baltimore). 2019;98(36):e17040). He completed a course of penicillin and steroids with clinical improvement, and the diagnosis of secondary syphilis was made. Discussion: This case illustrates the importance of maintaining a broad differential diagnosis, and carefully examining all labs, imaging, pathology and symptoms in order to determine the definitive diagnosis. It also illustrates the importance of teamwork when faced with a challenge requiring input from multiple subspecialties to arrive at a final diagnosis.