A 17-year-old male with nephrotic syndrome and diffuse adenopathy: Answers

Excerpt

With the history of diffuse adenopathy and nephritic syndrome, we initially suspected that the patient had lymphoma. However, the patient had membranous glomerulonephritis due to secondary syphilis. This diagnosis was suspected when the patient’s rapid plasma regain (RPR) test result came back positive with a titer of 1:128 after the biopsy had been performed. Although false positive RPR can be seen in systemic lupus erythematosus and this patient did have two female family members with end stage renal disease at a young age, secondary syphilis was confirmed by Treponema pallidum particle agglutination assay testing, which was positive in this case. In retrospect, the rash described by the patient, although no longer present on admission, matches the description of the classic maculopapular rash most commonly associated with secondary syphilis. …