Supplementary Material for: Cholestatic hepatitis with concomitant nephrotic syndrome due to secondary syphilis in a young man

A 23-year-old male presenting with fatigue, increasing abdominal pain, and poor appetite. Initial evaluation showed abnormal liver function tests with hyperbilirubinemia. Viral hepatitis, autoimmune, and metabolic disorders were ruled out. Urinalysis revealed significant proteinuria accompanied with hypertension. Serological tests confirmed secondary syphilis with reactive RPR and TPHA. Kidney biopsy indicated membranous nephritis. The patient received penicillin G Benzathine, antihypertensive, and antiproteinuric therapy. After 3 months, proteinuria resolved, and liver enzymes normalized. Syphilis is a re-emerging sexual transmitted disease with heterogeneous clinical presentation that should be considered in the differential diagnosis of inexplicable simultaneous liver and kidney dysfunction in patients with high-risk sexual behavior. This case highlights the importance of considering syphilis in young patients with unexplained nephrotic syndrome and liver abnormalities.