With a working diagnosis of syphilis-related rapidly glomerulonephritis, patient was admitted and started on intramuscular benzathine penicillin G 2.4 million IU weekly for 3 doses, intravenous furosemide 40 mg twice daily, amlodipine 10 mg once daily by mouth, intravenous metoclopromide 10 mg thrice daily, intravenous omeprazole 20 mg once daily, and no salt added diet. She was also challenged with 500 milliliters of normal saline for possible superimposed pre-renal component due to vomiting. She did not receive steroid or any other form of immunosuppressive therapy. Two days after first dose of benzathine penicillin G, the serum creatinine declined rapidly from 9.28 to 7mg/dl. After the third dose it became 0.98 mg/dl and had been stable since (Table 2). Currently she feels well, non-edematous, normotensive and normal and stable renal function.

Table 2. Timeline of the patient’s serial laboratory investigation