The wrong Spirochaete? Acute kidney injury in a returning traveller with syphilis – a case report

Background Syphilis has seen an increased incidence in recent years and can have serious and irreversible consequences if left un-diagnosed and untreated. This case report describes a presentation of syphilis and acute kidney injury – a scenario sparsely described in existing literature. Case presen...

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Bibliographic Details
Published in:BMC infectious diseases Vol. 20; no. 1; pp. 1 - 4
Main Authors: Cook, Hannah, Gompels, Mark
Format: Journal Article
Language:English
Published: London BioMed Central 21.09.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Acute kidney injury
Acute tubular necrosis
Antibiotics
At risk populations
Benzylpenicillin
Case Report
Case reports
Cefuroxime
Cytomegalovirus
Disease
Doravirine
Emergency medical care
Emergency medical services
Fever
Headache
Headaches
Health aspects
Hepatitis
HIV
Human immunodeficiency virus
Infections
Infectious Diseases
Injuries
Internal Medicine
Intravenous administration
Investigations
Kidney diseases
Kidneys
Knowledge bases (artificial intelligence)
Leptospirosis
Medical Microbiology
Medicine
Medicine & Public Health
Parasitology
Penicillin G
Physicians
Renal function
Risk groups
Sexually transmitted diseases
Spirochetes
STD
Syphilis
Travelers
Tropical diseases
Tropical Medicine
Viruses
Vomiting
United Kingdom > UK
Central America
Acute tubular necrosis
Case report
HIV
Acute kidney injury
Syphilis
ISSN:1471-2334, 1471-2334
Online Access:Get full text
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Summary:Background Syphilis has seen an increased incidence in recent years and can have serious and irreversible consequences if left un-diagnosed and untreated. This case report describes a presentation of syphilis and acute kidney injury – a scenario sparsely described in existing literature. Case presentation This 43-year old Man who has Sex with Men (MSM) presented to the emergency department with a 3-week history of vomiting and headaches, progressing to include pyrexia. These symptoms started following his return from a 2-week cruise in Central America throughout which he had been well. He had a background of well-controlled human immunodeficiency virus (HIV). On admission he had an Acute Kidney Injury (AKI) stage 3, without hydronephrosis, presumed to be pre-renal. Leptospirosis, the main differential, was negative serologically. ‘Pyrexia of unknown origin’ testing was performed, and cefuroxime commenced. Later in the admission, syphilis testing indicated an acute infection and he completed a full treatment course of benzylpenicillin. This, alongside intravenous fluids, resulted in symptom and renal resolution in 9 days and restoration of renal function. Conclusions Renal complications in syphilis are rare, furthermore the majority of those documented occur in latent syphilis and are irreversible. There are limited numbers of other documented cases of AKI in acute syphilis, which like the gentleman in this case were reversible and did not lead to permanent kidney damage. This case adds to the knowledge base of AKI in initial presentation of syphilis. It also demonstrates not only the importance of taking a sexual history in patients with new infective symptoms but that testing for syphilis in at-risk groups regardless of history should be performed given its rising incidence. These considerations by physicians can lead to prompt diagnosis and management of syphilis and improve patient care and long-term outcomes.
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ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-020-05418-4