The global incidence of primary and secondary syphilis is increasing in high-risk groups. However, pulmonary syphilis remains exceedingly rare with less than 30 cases recorded since 1967. Of these cases, none have recorded the presence of both pulmonary and renal involvement with nephrotic syndrome. Diagnosis of pulmonary syphilis remains a challenge, and there is no consensus on treatment. We report a case of a 46-year-old male with secondary pulmonary syphilis and concomitant nephrotic syndrome.