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위장, 간 침범과 함께 막성 신병증이 합병된 제2기 매독
권현희 ( Kwon Hyeon Hui ),우창민 ( U Chang Min ),오효진 ( O Hyo Jin ),안기성 ( An Gi Seong ),조창호 ( Jo Chang Ho ),김용진 ( Kim Yong Jin ),이인희 ( Lee In Hui ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.1
Syphilis, caused by the spirochete Treponema pallidum, is a chronic systemic infectious disease. Nephrotic syndrome, hepatitis, or gastric involvement resulting from secondary syphilis are well-documented complications, but very rare. Moreover, the simultaneous occurrence of these complications in the same patient is extremely rare. This report describes 43-year old male patient with syphilis presented with features of nephrotic syndrome, acute hepatitis, and gastric involvement. A diagnosis of secondary syphilis was nade by skin lesions and serologic tests for syphilis. After a diagnosis of syphilis, we supposed that nephrotic syndrome and hepatitis were the complications of sccondary syphilis and performed kidney and liver biopsies. A kidney biopsy revealed membranous nephropathy characterized by subepithelial hump-like electron-dense deposits and effacement of epithelial foot-processes on electron microscopy. A liver biopsy showed a feature of lobular hepatitis with a few granulomas. Esophagogastroduodenoscopy (EGD) showed multiple shallow ulcers with varying degrees of nodular mucosa at gastric antrum. The patient was treated with intramuscular benzathine penicillin G, 2.4 million units. Proteinuria, skin lesion, hepatitis, and EGD finding were resolved rapidly after penicillin therapy. In conclusion, syphilis should be considered in the differential diagnosis of the nephrotic syndrome, hepatitis, and gastric involvement occurring separately or simultaneously. (Korean J Nephrol 2004;23(1):152-157)