A 59-year-old man with a history of type 2 diabetes and a left nephrectomy following trauma reported of malaise and weakness. He reported a penile ulcer 2 months earlier, but there had been no lymphadenopathy or fever. His speech was slurred, he was breathless on minimal exertion and there was ankle swelling. Twenty-four hours later he developed a generalised maculopapular rash. Laboratory investigation confirmed syphilis and nephrotic syndrome. He was treated with a single injection of benzylpenicillin following which there was a rapid and complete recovery. The temporal association and improvement with treatment suggest that syphilis caused his illness. The incidence of syphilis is increasing and doctors should remain alert to syphilis as a possible cause of the nephrotic syndrome.
2014 BMJ Publishing Group Ltd.