Abstract
A thirty five year old unmarried man had a chance of venereal exposure on July in 1978. Three months later, right inguinal lymphadenopathy and low grade fever developed and the Wasserman reaction was positive. Six months later, he noticed decreased urine volume, facial edema, general malaise and roseola. He was admitted to the hospital on March in 1979. On physical examinations, he was found to have typical roseola and mild anemia, but no jaundice. T. protein and albumin levels were 5.5 and 2.3g/dl, respectively. There existed moderate renal dysfunction (BUN 36.8, creatinine 3.0mg/dl and Ccr. 39ml/ min). T, chol. level was within normal range. Urinary excretion of protein was amounted up to 5 g/day. Alkaline phosphatase was elevated markedly (more than 88 K. A.U.). G.0.T. was 88 I.U. and B.S.P. was 13.5%. The Wasserman reaction was positive (×320), TPHA 2+, FTA positive (×1280). HbsAg, ASK and ASLO were all within normal range. Skin biopsy disclosed pericapillary infiltration of plasma cells consistent with syphilitic roseola. On renal biopsy minimal change was shown in LM, bease-like staining of anti-IgG along the glomerular capillary wall in IF, and subepithelial dense deposits and foot process fusion in EM. The liver biopsy showed nonspecific pericholangitis without spirochete. On the basis of these findings, he was diagnosed as having secondary syphilis associated with nephrotic syndrome and acute hepatitis. All abnormal findings were normalized after Penicillin-G treatment (1.2million units/day, i.m.).
