[Extramembranous glomerulonephritis of acquired syphilis in a patient recently infected by the hepatitis B virus. Demonstration of the treponemal antigen in the kidney by indirect immunofluorescence].
A 38 years old male homosexual with active secondary syphilis presented with pure nephrotic syndrome while HBs and HBe tests were positive without clinical hepatitis. He had circulating immune complexes, IgG--IgM cryoglobulinemia and high IgA, IgM and IgE levels; the C3 and C4 complement constituents were normal. Examination of renal biopsy sections under light, fluorescent and electronic microscopy showed stage I membranous glomerulonephritis the syphilitic origin of which was confirmed by indirect immunofluorescence and by rapid cure under penicillin treatment. This case calls for the following comments: (1) glomerular deposits are extramembranous rather than subendothelial in syphilitic nephrosis, a disease now classified among circulating immune complexes diseases; (2) in the kidney, the treponema antigen can be demonstrated by indirect immunofluorescence and the anti-treponema antibody, by elution; (3) the outcome of the nephrotic syndrome is always favourable, either spontaneously or after penicillin treatment; (4) syphilis and HBs antigens are frequently associated, particularly in homosexual patients; one should be looked for when the other is discovered.
D000328:Adult; D000942:Antigens, Bacterial / Q000032:analysis*; D005455:Fluorescent Antibody Technique; D005921:Glomerulonephritis / Q000209:etiology* / Q000276:immunology; D006509:Hepatitis B / Q000150:complications*; D006716:Homosexuality; D006801:Humans; D007668:Kidney / Q000276:immunology; D008297:Male; D009404:Nephrotic Syndrome / Q000276:immunology; D013587:Syphilis / Q000150:complications*; D014210:Treponema pallidum / Q000276:immunology*
D000942:Antigens, Bacterial
Glomérulonéphrite extra-membraneuse de la syphilis acquise chez un malade récemment infecté par le virus de l'hépatite B. Mise en évidence au niveau du rein de l'antigène tréponémique par immunofluorescence indirecte.