DIAGNOSIS OF EXTRA MEMBRANOUS GLOMERULONEPHRITIS (EMG) IN AFRICA: REPORT OF A CASE OF LATENT SYPHILIS

Introduction: Syphilis is a disease caused by the spirochete Treponema pallidum. It can be acquired (sexually transmitted via the mucous membranes or, more exceptionally, via blood transfer) or congenital (via maternal-fetal passage). Observation: A 47-year-old patient was admitted to the Nephrology department of the Bouaké University Hospital for the exploration of an edematous syndrome Medical history was marked by a syphilitic infection in adolescence treated with antibiotics and undocumented urogenital bilharzia. The clinical examination revealed large edema of the lower limbs and dyspnea at stage 2 of NHYA. Blood pressure was normal. The urine dipstick found albuminuria at 3+, hematuria 2+, without leukocyturia. The biological assessment showed nephrotic syndrome (proteinuria 7.74g/24H and albuminemia 18g/L) and renal failure (creatinine at 33mg/L). Antinuclear antibodies, rheumatoid factors, antineutrophil cytoplasmic antibodies, anti PLA2R and thrombospondin type 1 domain containing 7A (THSD 7A) were negative. C3, C4 and IgA levels were normal. PSA dosage was normal. Serologies for hepatitis B and C, HIV1 and 2, bilharzia and malaria were negative. VDRL and TPHA were positive at 1/160 for each. PBR had found GEM. Evolution was unfavorable under penicillin G benzathine but secondarily associated with cyclosporine and corticosteroid therapy, we had found proteinuria at 0.33g/24H, albuminemia at 33g/L and creatinine at 12.4mg/L in 8 weeks. Discussion: renal biopsy found GEM. After penicillin antibiotic therapy, partial remission of her nephrotic syndrome was noted at 4 weeks followed by a relapse after one week. A trial treatment with immunosuppressant and corticosteroid therapy had resulted in complete remission of the nephrotic syndrome. Conclusion: Although the incidence of syphilis in Africa is increasing, we should not ignore primitive GEM on a terrain of latent syphilis.