Benzathine Penicillin Research Articles

Lidocaine Reducing Pain from Benzathine Penicillin Injection: A Controlled Trial

Postoperative cognitive dysfunction (POCD) is an event that alarms medical personnel owing to its adverse effects, including heightened morbidity and mortality rates, prolonged recovery times, and increased lengths of hospital stay and healthcare expenditure. The populations at high risk are elderly, critical patients, or complicated cases that need prolonged surgery in which the hemodynamics are not stable. Although guidelines have been established to facilitate the early diagnosis of POCD, its prevention is recommended for good patient outcomes. A preoperative assessment is a prerequisite for patient optimization before surgery. Intraoperative, enhanced-recovery protocols have been widely adopted to promote recovery following surgery. Frequent, postoperative assessments of patients’ vital signs and cognitive functions are required for early POCD detection. Patients diagnosed with POCD need regular follow-up, and proper patient counselling is paramount.

Rheumatic heart disease in the heart of Himalayas.

Rheumatic heart disease results from the damage to heart valves caused by one or more episodes of rheumatic fever leading to a variety of cardiac complications. Although less common in developed parts of the world, it is one of the most common acquired heart diseases in low- and middle-income countries including Nepal, affecting children and young people. Primary prevention with prompt treatment of streptococcal throat infections and long-term secondary antibiotic prophylaxis with benzathine penicillin G are the key intervention strategies. Echocardiography based screening in schoolchildren has become an effective measure for early identification of the cases. More coordinated policies and effective interventions are needed to successfully decrease the burden of the rheumatic heart disease in resource limited settings like Nepal.

Congenital Infections: Priorities and Possibilities for Resource-limited Settings.

Congenital Infections: Priorities and Possibilities for Resource-limited Settings.

Bioethanol Production from Various Lignocellulosic Materials by Encapsulated Saccharomyces cerevisiae NCIM 3095

Bioethanol has a greater promise for environmental safety and energy security than fossil fuels. The alternate source required to meet the fuel's requirements can be provided by bioethanol. Untapped sugar-rich sources, like cellulose-rich household wastes, industrial wastes, and agricultural wastes, can all be used to make bioethanol at a minimal cost. The study's objective was to determine whether saccharomyces cerevisiae cells from the encapsulated NCIM 3095 strain of Saccharomyces cerevisiae could be used to make low-cost ethanol from a variety of lignocellulosic wastes, including newspaper, banana leaves, gram straw, soybean straw, and cow dung. To reduce bacterial contamination and serve as an external growth stimulator, benzathine penicillin G and ammonium sulfate were added to each sample broth containing calcium alginate-encapsulated yeast cells. The samples were fermented for ten days. The ethanol content was evaluated every three days. The largest yield of bioethanol was produced by soybean straw (10.0%), while the lowest was by cow dung (4.0%).

Promising approaches to early diagnosis of chronic rheumatic heart disease

Aim to determine the prevalence of acute rheumatic fever (ARF) in children and chronic rheumatic heart disease (HRHD) in adults on the example of the Samara region and to propose measures for the early detection and prevention of valvular heart lesions.
 Material and methods. The authors cite the material of their own research, indicating a significant prevalence of rheumatic etiology of valvular lesions that required surgical treatment in 20162020 in the Samara region. We retrospectively analyzed the prevalence of acute rheumatic fever and chronic rheumatic heart disease in out-patients of a large polyclinic of Samara city.
 Results. The study demonstrates the low frequency of acute rheumatic fever in the Russian Federation along with the disproportionately high prevalence of chronic rheumatic heart disease.
 Conclusion. It is advisable to supplement the procedure for preventive medical examinations of the underage, has being in force in the territory of the Russian Federation since 2017, by ultrasound examination of the heart for the timely diagnosis of chronic rheumatic heart disease and long-term treatment with benzathine penicillin. In this case, it is also possible to identify previously undiagnosed congenital heart defects and heart diseases that manifest in adolescence.

Secondary Prevention of Rheumatic Heart Disease in Nepal: Are We Going Backward?

A secondary level of prophylaxis has proven to be the most successful in Nepal, a country with an endemic rate of rheumatic heart disease, in combating the severe issues associated with rheumatic heart disease. The use of benzathine penicillin G in secondary prophylaxis of rheumatic heart disease, recommended by several guidelines, has been increasingly abandoned in Nepal due to a lack of national guidelines and the termination of the prior programs. The use of oral penicillin and alternative oral antibiotics, which are less effective in preventing the recurrence of acute rheumatic fever, is on the rise. Nepal urgently needs to develop new national guidelines and ensure their effective implementation in order to slow the increase in the number of rheumatic heart disease patients. In this article, we explore the limitations, challenges, and advantages of using the consensus-supported intramuscular benzathine penicillin G as the first-line drug for the secondary prevention of rheumatic heart disease.

A Review on the Diagnosis and Treatment of Syphilis

Syphilis is a multi-phase sexually transmitted disease through contacting with a partner infected by syphilis or from a gravida to her newborn congenitally. The reappearance of syphilis is a severe public health concern, particularly because syphilis lesions would boost the chance of acquiring and spreading human immunodeficiency virus (HIV) infection. A dose of benzathine penicillin G (BPG) through intramuscular injection is the current treatment for syphilis, which is the optimal treatment for all stages of syphilis. Although some alternatives such as doxycycline and ceftriaxone are also evidently effective, the optimal therapy is still BPG, especially in latent syphilis and pregnancy. Because of the clinically significant azithromycin resistance, this second-line medication is no longer used routinely. Currently, macrolide resistance is the only antibiotic resistance with clinical evidence. Even though still no vaccine is published for syphilis, syphilis is a promising disease for vaccine development. The vaccine for syphilis is currently under research. This paper contained information about the pathological process, symptoms, diagnosis of syphilis, and effective treatment using antibiotics. The review also discussed future vaccine directions.

ORAL SYPHILIS IN AN ADULT PATIENT WITH AN INITIALLY VDRL NEGATIVE TEST

We report an uncommon presentation of oral syphilis in a male patient, 29 years old with a 2-month mouth ulcer. Clinical examination showed right submandibular lymphadenopathy and a painless ulcer located on the right labial commissure. Serology was requested for syphilis (VDRL) and HIV—both nonreactive—and a complete blood count that showed no changes. An incisional biopsy was performed with a diagnosis of an inflammatory process. Histochemical stains, such as Ziehl Nielsen and PAS, were requested, in addition to serology for toxoplasmosis and histoplasmosis, which were all nonreactive. Two months later, due to the persistence of the lesion, FTA-ABS and VDRL were requested again, and both were positive, characterizing syphilis. Afterward, treatment with benzathine penicillin 1,200,000 UI (2 applications/3 weeks) was proposed, and the patient remains in follow-up.

ORAL MANIFESTATION OF PRIMARY SYPHILIS

Syphilis is a bacterial infection caused by <i>Treponema pallidum</i>, which can be transmitted mainly through unprotected sexual contact or vertical transmission. This disease can manifest itself in the primary, secondary, and tertiary stages. The most important laboratory tests for diagnosis are treponemic and nontreponemic tests. A 23-year-old male patient attended the oral medicine clinic reporting an asymptomatic upper lip vermilion lesion. The physical examination revealed an ulcerated lesion with a clear base in the vermilion of the upper lip, on the right side, of approximately 1.0 cm. Clinically, the diagnostic hypothesis was chancre. Incisional biopsy and serological tests for syphilis and human immunodeficiency virus were performed. The histopathologic examination confirmed the diagnostic hypothesis, and the tests obtained positive results only for syphilis. Treatment was performed with a single dose of benzathine penicillin and the lesion regressed, testing negative in the Venereal Disease Research Laboratory after 3 months.

Population pharmacokinetic study of benzathine penicillin G administration in Indigenous children and young adults with rheumatic heart disease in the Northern Territory, Australia.

Benzathine penicillin G (BPG) is the cornerstone of secondary prophylaxis to prevent Streptococcus pyogenes infections, which precede acute rheumatic fever (ARF). The paucity of pharmacokinetic (PK) data from children and adolescents from populations at the highest risk of ARF and rheumatic heart disease (RHD) poses a challenge for determining the optimal dosing and frequency of injections and undermines efforts to develop improved regimens. We conducted a 6 month longitudinal PK study of young people receiving BPG for secondary prophylaxis. Throat and skin swabs were collected for microbiological culture along with dried blood spot (DBS) samples for penicillin concentrations. DBSs were assayed using LC-MS/MS. Penicillin concentration datasets were analysed using non-linear mixed-effects modelling and simulations performed using published BMI-for-age and weight-for-age data. Nineteen participants provided 75 throat swabs, 3 skin swabs and 216 penicillin samples. Throat cultures grew group C and G Streptococcus. Despite no participant maintaining penicillin concentration &gt;20 ng/mL between doses, there were no S. pyogenes throat infections and no ARF. The median (range) observed durations &gt;20 ng/mL for the low- and high-BMI groups were 14.5 (11.0-24.25) and 15.0 (7.5-18.25) days, respectively. Few patients at highest risk of ARF/RHD receiving BPG for secondary prophylaxis maintain penicillin concentrations above the target of 20 ng/mL beyond 2 weeks during each monthly dosing interval. These PK data suggest that some high-risk individuals may get inadequate protection from every 4 week dosing. Future research should explore this gap in knowledge and PK differences between different populations to inform future dosing schedules.

Annular rupioid secondary syphilis confined to the face

ObjectivesSyphilis is a sexually transmitted infection (STI) caused by treponema pallidum. Its rash usually affects the trunk and limbs extensively, including the palms and soles of the feet. Secondary syphilis confined to the face is extremely rare. MethodsWe report a case of annular rupioid secondary syphilis, which was misdiagnosed as verruca vulgaris. ResultsThe patient's lesions were confined to the face and resembled oyster shells. Her serological tests results were positive for treponema pallidum particle agglutination assay (TPPA) and rapid plasma reagin (RPR) (1:64). ConclusionAccording to epidemiological history, clinical presentation, non-treponemal tests, treponemal tests, and effective benzathine penicillin G treatment, confirmed secondary syphilis.

Investigating latent syphilis in HIV treatment-experienced Ethiopians and response to therapy.

We investigated people with HIV (PWH) receiving combination antiretroviral therapy (cART) for latent syphilis infection prevalence, risk factors, treatment response, and neurosyphilis. A prospective follow-up study was conducted on PWH and latent syphilis. The cases were randomly assigned to receive either benzathine penicillin G (BPG) or doxycycline (DOXY), and the posttreatment response was evaluated after 12 and 24 months. The traditional algorithm was used for serodiagnosis, and a semi-quantitative rapid plasma reagin (RPR) test monitored disease activity and treatment effectiveness. Of the 823 participants, 64.8% were women, and the mean age was 41.7±10 years. Thirty-one (3.8%) of the participants (22 males and nine females) had latent syphilis. The risk factors were male sex (aOR = 3.14), increasing age (aOR = 1.04 per year), and cART duration (aOR = 1.01 per month). Baseline RPR titers were: ≤1:4 in 19 (61.3%), between 1:8 and 1:32 in 10 (32.2%), and >1:32 in 2 (6.4%). None of the seven cerebrospinal fluid analyses supported a neurosyphilis diagnosis. In the 12th month of treatment, 27 (87.1%) had adequate serological responses, three (9.7%) had serological nonresponse, and one (3.2%) had treatment failure. Syphilis treatment was repeated in the last four cases with the alternative drug. In terms of adequate serologic response, both therapies were comparable at the 12th month, p = 0.37. All cases responded to treatment in the 24th month. In PWH receiving cART, latent syphilis occurred more in men than women, suggesting an investigation of sexual practices and the impact of antenatal syphilis screening. Syphilis disease activity reduces in the latent stage. Therefore, the routine cerebrospinal fluid analysis contributes little to the diagnosis of asymptomatic neurosyphilis and the treatment success of latent syphilis. DOXY is an alternative to BPG, and cART improves serologic response to latent syphilis treatment.

Multimodal imaging in syphilitic retinitis with vasculitis in an immunocompetent patient

A 47-year-old male reported a sudden diminution of vision in the left eye for 1 month. Fundus examination showed dense vitritis, retinal hemorrhages around the disc with subretinal precipitates. Peripheral examination revealed snowball opacities. Multimodal imaging indicated syphilitic retinitis with vascular leakage. A complete systemic workup was performed to support the diagnosis. Intramuscular benzathine penicillin injection along with oral corticosteroids showed an excellent response as confirmed by the multimodal imaging. Syphilitic retinitis with vasculitis is uncommon and can occur in immunocompetent patients. Multimodal imaging can be used to demonstrate the extent of involvement and to monitor treatment response.

Amoxicillin as an Option in Congenital Syphilis Management: A Case Report

BACKGROUND: Congenital syphilis (CS) is the second leading cause of preventable stillbirth globally. This case report shows that CS baby can be managed by amoxicillin with good results. CASE PRESENTATION: A term female baby was born through section cesarean on suspicion of syphilis of a 29-year-old mother, G4P3A0, 39 weeks gestation with normal APGAR score, and birth weight was 2330 g, birth length was 46 cm, and head circumference 32 cm. There are no abnormalities on physical examination. The baby is active and clinically sound. In history taking, the mother was diagnosed with syphilis in the first trimester of pregnancy but did not want to be treated. After birth, maternal serology showed that Treponema pallidum is reactive. Maternal VDRL was reactive at 1:1, while TPHA was reactive at 1:2560. Baby laboratory results showed Hb 18.4 g/dL, leukocytes 33,480/μL, platelets 278,000/μL, and hematocrit 54.7%. A peripheral blood smear showed neutrophilia with hypersegmentation and monocytosis due to suspected chronic inflammation. Baby VDRL was reactive at 1:16, while TPHA was reactive at 1:1280. The diagnosis was congenital syphilis with low birth weight and small for gestational age. After one month of treatment with oral amoxicillin, baby VDRL was reactive at 1:2, while TPHA was reactive at 1:320. At 1½ months, the baby’s hemoglobin is 10.1 g/dL. X-rays for chest, abdomen, and skeletal were within normal limits. The baby was given oral amoxicillin 50 mg/kg/day for a total of 3 months. When the baby was 4 months old, her growth and development were good with the VDRL reactive 1:1 and the TPHA reactive 1:160. CONCLUSION: In the unavailability of benzathine penicillin, amoxicillin may be considered an option in CS management.

Analysis of serological treatment response to doxycycline versus benzathine penicillin in syphilis infections, a retrospective single-center study.

Doxycilicine is the second‐line treatment of choice for infectious syphilis when treatment with penicillin G is not feasible. To date, difficulties in the penicillin supply chain make it necessary to evaluate and resort to antibiotic therapies which are currently considered a second‐line choice. Moreover, systematic studies comparing the two treatments in affected patients are still few, and many do not consider late and indeterminate latent infections. The objective of this study was to assess the differences in the serological response of the treatment of syphilis infections with benzathine penicillin compared with doxycycline. We built an in‐house database with all patients diagnosed with syphilis infection from January 2010 to January 2020 in the STD Centre of the S.Orsola‐Malpighi Polyclinic of the University of Bologna, located in the North‐east of Italy. We recorded all the principal independent (demographic, social status, reinfection rare, HIV infections, comorbidities, sexual behaviors, and initial TPHA values) and dependent variables (RPR values). We then extrapolated all patients treated with doxycycline (100 mg of doxycycline twice daily for 14 days for infections diagnosed within the first year and a 28 days course for infections older than 1 year or undetermined) and matched in 1:1 ratio numbers with a homogeneous group of patients treated with penicillin G (2.4 million units in a single dose intramuscularly for infections diagnosed within the first year and a cycle consisting in of 2.4 million units administered in a single dose per week for 3 weeks for infections older than 1 year or undetermined) We then analyzed the serological trends and outcomes in the primary, secondary and early latent groups versus late latent and undetermined infections. We retrieved 41 patients for each group with homogeneous initial characteristics. At the end of the 24‐month observation period, a slight difference in a valid RPR reduction rate emerged, with a greater success rate emerged in patients receiving penicillin than those with doxycycline (26 vs. 22, p 0.615). Indeed, patients with latent or indeterminate syphilis treated with doxycycline appear to have a higher rate of serofast than those treated with penicillin. Linear regression analysis showed no strong correlation between the analyzed independent variables and the observed outcomes. Doxycycline had a slightly lower, though not statistically different, success rate when compared with penicillin in treating primary syphilis, but appeared to have a reduced success rate in attaining resolution in late and undetermined syphilis infection.

SECONDARY PULMONARY SYPHILIS

TYPE: Late Breaking Case Report TOPIC: Chest Infections INTRODUCTION: Syphilis is a sexually transmitted disease that can affect any organ in its secondary stages. We describe a case of secondary syphilis with pulmonary involvement. CASE PRESENTATION: A 57 years old male came with SOB and cough since 1 week. He had history of fever, skin ulcers since1 month.He admits history of sexual exposure with commercial sex worker. CECT CHEST – Ground glass and nodular opacities in left upper and lower lobes. Punched out skin ulcers of 1x1 cm are seen over scrotum and right thigh. Veneral Disease Research Laboratory, Treponema Pallidum Haemagglutination,Flourescent Treponemal Antibody-Absorption - REACTIVE. • The diagnosis of secondary pulmonary syphilis was made based on History, Clinical examination, Serological tests for syphilis and Clinical improvement with anti syphilitic treatment. He was treated with BENZATHINE PENICILLIN 2.4 MU I.M per week for 4 weeks. Patient was followed for next 6 months.His skin lesions and lung infiltrates were completely cured in susequent examination. DISCUSSION: In 1983, Coleman et al.proposed five criteria for the clinical diagnosis of secondary syphilis with pulmonary involvement: [1] History and physical findings typical of secondary syphilis;[2] Serologic test results positive for syphilis;[3] Pulmonary abnormalities seen on radiographs with or without associated pulmonary symptoms or signs;[4] Exclusion of other forms of pulmonary disease when possible, using serologic tests, sputum smears and cultures, and cytologic examination of sputum; and[5] Therapeutic response to anti-syphilitic treatment visible on radiographs. CONCLUSIONS: Pulmonary syphilitic involvement should be suspected where clinical history along with pulmonary symptoms and radiological changes occur in cases positive for serological markers. DISCLOSURE: Nothing to declare. KEYWORD: SECONDARY PULMONARY SYPHILIS

Etiological Surveillance of Genital Ulcer Syndrome in South Africa: 2019 to 2020.

Herpes simplex virus (HSV) has been the leading cause of genital ulcer syndrome (GUS) in South Africa for more than a decade, and acyclovir therapy is incorporated into syndromic management guidelines. We conducted surveillance at 3 sentinel sites to define the common sexually transmitted etiologies of GUS and to determine whether current syndromic management is appropriate. Secondary objectives of surveillance were to determine the seroprevalence of coinfections (HIV, syphilis, HSV-2) in persons presenting with GUS. Consecutive, consenting adult men and women presenting with visible genital ulceration were enrolled between January 1, 2019, and December 31, 2020. Genital ulcer swab and blood specimens were collected and transported to a central sexually transmitted infection reference laboratory in Johannesburg. Among 190 participants with GUS, HSV-2 was the most frequently detected ulcer pathogen (49.0%; 95% confidence interval [CI], 41.9%-56.1%). The relative prevalence of the second most common ulcer-derived pathogen, Treponema pallidum, was 26.3% (95% CI, 20.5%-33.1%), with 90% of primary syphilis cases having a positive rapid plasma reagin (RPR) titer. Male sex was independently associated with primary syphilis compared with herpetic ulcers, after adjusting for the effect of casual sex partners and other exposures (adjusted odds ratio, 3.53; 95% CI, 1.35-9.21; P = 0.010). The overall HIV prevalence among participants was 41.3% (78 of 189; 95% CI, 34.2%-48.6%). Herpes simplex virus 2 remains the predominant cause of GUS, justifying the continued use of acyclovir in syndromic guidelines. Adequate supplies of benzathine penicillin G for syphilis treatment are essential at primary health care level, in addition to the provision of syphilis and HIV risk reduction services.

Females treated for syphilis in Bialystok, Poland 2016-2020.

Syphilis is the third most frequent bacterial sexually transmitted disease globally. Untreated syphilis in a pregnant woman may results in a transmission of the infection to the foetus resulting in congenital syphilis. To characterise females treated for syphilis in Bialystok, north-east Poland, in years 2016-2020. Retrospective analysis of age, residency, marital status of patients, stage of syphilis, treatment and adherence to follow-up visits was conducted as well as a detailed analysis of clinical characteristics of pregnant women treated for syphilis. Sixteen women were treated for syphilis in 2016-2020, 11 (68.8%) of them were pregnant. The proportion of pregnant women among all syphilis female patients increased substantially as compared to years 2000-2015 (68.8% vs. 36.2%, respectively, P<0.05). Mean age of patients was 37.12±11.25 years, 10 (62.5%) were residents of urban areas and 10 were married. Late latent syphilis or latent of unknown duration was the most frequent stage of syphilis. Chlamydia trachomatis infection was detected in four (25%) patients with syphilis. Benzathine penicillin was mainly used in the treatment. More than half of patients did not complete follow-up. Only one pregnant woman was treated within the first trimester and five of them (45.45%) were lost to follow-up and the outcome of pregnancy was unknown. Syphilis in females, especially in pregnant ones, is an important problem in the Podlaskie voivodeship. The proportion of pregnant females among all female patients with syphilis is increasing. The detection and the treatment of infection is frequently delayed in pregnant females. The after treatment followup and the knowledge of outcome of pregnancy remains unsatisfactory. The collaboration between dermatovenereologists, gynaecologists and obstetricians should be improved.

Assessment of country implementation of the WHO global health sector strategy on sexually transmitted infections (2016-2021).

BackgroundIn 2016, WHO launched the Global Health Sector Strategy on STIs, 2016–2021 (GHSS) to provide guidance and benchmarks for country achievement by 2020 and four global targets for achievement by 2030.MethodsA country survey jointly developed by experienced technical personnel at WHO Headquarters (HQ) and WHO regional offices was reviewed and distributed by WHO regional advisors to 194 WHO Member States in September-March 2020. The survey sought to assess implementation and prioritization of STI policy, surveillance, service delivery, commodity availability, and surveillance based on targets of the GHSS.ResultsA majority (58%, 112/194) of countries returned a completed survey reflecting current (2019) STI activities. The regions with the highest survey completion rates were South-East Asia Region (91%, 10/11), Region of the Americas (71%, 25/35) and Western Pacific Region (67%, 18/27). Having a national STI strategy was reported by 64% (72/112) and performing STI surveillance activities by 88% (97/110) of reporting countries. Availability of STI services within primary health clinics was reported by 88% of countries (99/112); within HIV clinics by 92% (103/112), and within reproductive health services by 85% (95/112). Existence of a national strategy to eliminate mother-to-child transmission of HIV and syphilis (EMTCT) was reported by 70% of countries (78/112). Antimicrobial resistance (AMR) monitoring for gonococcal infection (gonorrhoea) was reported by 64% (57/89) of reporting countries with this laboratory capacity. Inclusion of HPV vaccine for young women in the national immunization schedule was reported by 59% (65/110) and availability of cervical cancer screening was reported by 91% (95/104). Stockouts of STI medicines, primarily benzathine penicillin, within the prior four years were reported by 34% (37/110) of countries.ConclusionsMechanisms to support improvements to STI service delivery through national-level policy, commitment, programming and surveillance are needed to operationalize, accelerate and monitor progress towards achievement of the 2030 global STI strategy targets.

MO202: Pulmonary-Renal Syndrome in Patient with Chronic Hepatitis C And HIV Disease

Abstract BACKGROUND AND AIMS Pulmonary-renal syndrome (PRS) is characterized by rapidly progressive glomerulonephritis and lung vasculitis. Most common causes of PRS are Goodpasture's disease, antineutrophil cytoplasm antibody (ANCA) associated vasculitis and systemic lupus erythematosus; rarely it could be caused by cryoglobulinemic vasculitis. ANCA and cryoglobulins are present in a wide range of infectious, inflammatory and malignant conditions with or without evidence of clinical vasculitis. ANCA positivity has been described in patients with human immunodeficiency virus (HIV) or chronic hepatitis C (HCV), but only a negligible proportion of these patients developed true ANCA vasculitis. Cryoglobulinemia is seen in ∼50% of patients with HCV and ∼5% of these patients have symptomatic disease. According to previous studies, rapidly progressive glomerulonephritis and pulmonary involvement are rare manifestations of cryoglobulinemia. We describe a patient with HIV and HCV infection who presented with rapidly progressive glomerulonephritis and lung vasculitis. METHOD Case report presentation. RESULTS A 43-year-old male presented with fatigue, nausea and decreased urinary output of 3–4 days. Vital signs were stable and physical examination showed abdominal distention and peripheral oedema. His past medical history included heroin abuse. However, he denied any illicit drug use, and he had been on methadone maintenance treatment for 8 years. The patient was diagnosed with HIV 11 years previously. His antiretroviral therapy included abacavir, dolutegravir and lamivudine. CD4 count before admission was 180–200 cells/mm3. In addition to HIV infection, the patient had HCV diagnosed 20 years ago, but he has not received any treatment. The laboratory tests revealed pancytopenia (leukocytes 1.3 × 109/L, haemoglobin 66 g/L, platelets 66 × 109/L), kidney injury (proteinuria 0.8 g/24 h and haematuria) with renal insufficiency (creatinine 727 mcmol/L, urea 36.6 mmol/L). Ultrasound workup demonstrated diffuse changes in liver parenchyma with signs of portal hypertension, and normal-sized, non-obstructed kidneys with Grade 0 parenchymal echogenicity. Chest CT revealed wide areas of ground-glass opacity with patchy airspace consolidations, more severe in the left upper lobe. A serologic workup was positive for cryoglobulins, ANA, c-ANCA (high titre of anti-PR3 143 IU/mL), with decreased levels of C3 and C4. CRP level was slightly elevated (40 mg/L). Moreover patient had positive treponemal and non-treponemal syphilis serological tests. An ultrasound-guided renal biopsy showed crescentic glomerulonephritis with predominant IgM and focal C3, C1q deposition in glomerular capillary walls without any significant glomerular proliferative features. Changes could be interpreted as an immune complex and/or cryoglobulin-mediated glomerulonephritis, but overlapping pauci-immune glomerulonephritis could not be ruled out. Haemodialysis was initiated due to kidney failure and hyperhydration. The patient was treated with pulse methylprednisolone followed by a tapering course of oral prednisolone. Rituximab 1000 mg was prescribed after excluding HIV opportunistic infections, and treatment of syphilis with three doses of benzathine penicillin was used. Due to low GFR, HIV treatment was switched to Dolutegravir/Rilpivirine. The patient refused to initiate HCV therapy. The patient responded well to treatment and lung vasculitis and kidney function improved, therefore haemodialysis was discontinued. Serum creatinine level decreased to 130–120 mcmol/L and remained stable after 18 weeks since the treatment. CONCLUSION PRS in a patient with chronic infections, positive cryoglobulins and positive c-ANCA clinically seems more applicable to c-ANCA vasculitis than to cryoglobulinemic vasculitis. Still overlapping of both diseases could not be excluded.