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Klarić D, Žutelija M, Šenjug P, Klarić M, Galešić Ljubanović D. Crescentic Glomerulonephritis Due to Enterococcal Endocarditis. J Pers Med 2023; 13:1212. [PMID: 37623463 PMCID: PMC10455847 DOI: 10.3390/jpm13081212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Glomerulonephritis following an enterococcal endocarditis is an extremely rare and life-threatening condition. We present the case of a 71-year-old patient with rapidly progressive glomerulonephritis following enterococcal endocarditis after surgical replacement of the aortic valve. The combination of antibiotic therapy, corticosteroid therapy and haemodialysis led to an improvement in renal function; however, the severity of cardiac deterioration resulted in a fatal outcome.
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Affiliation(s)
- Dragan Klarić
- Department of Nephrology and Dialysis, Zadar General Hospital, Bože Peričića 5, 23000 Zadar, Croatia; (D.K.)
| | - Marta Žutelija
- Department of Nephrology and Dialysis, Zadar General Hospital, Bože Peričića 5, 23000 Zadar, Croatia; (D.K.)
| | - Petar Šenjug
- Unit of Nephropathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital, School of Medicine, University of Zegreb, 10000 Zagreb, Croatia;
- Institute of Pathology, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Marta Klarić
- School of Medicine, University of Rijeka, Ulica Braće Branchetta 20/1, 51000 Rijeka, Croatia
| | - Danica Galešić Ljubanović
- Unit of Nephropathology and Electron Microscopy, Department of Pathology and Cytology, Dubrava University Hospital, School of Medicine, University of Zegreb, 10000 Zagreb, Croatia;
- Institute of Pathology, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
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Granulicatella adiacens Subacute Bacterial Endocarditis Presenting as Diffuse Alveolar Hemorrhage and Infection-Related Glomerulonephritis. Case Rep Infect Dis 2022; 2022:5565906. [PMID: 35295623 PMCID: PMC8920634 DOI: 10.1155/2022/5565906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 12/17/2021] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 69-year-old male with a past medical history of prostate cancer, chronic mitral valve regurgitation, and recent dental cleaning who presented to the hospital with shortness of breath, anemia, and acute renal failure. Due to unexplained creatinine rise, a renal biopsy was obtained which was suspicious for infection-related glomerulonephritis (IRGN). Further workup confirmed subacute endocarditis according to modified Duke's criteria. The patient's blood culture became positive for Granulicatella adiacens, a nutritionally variant streptococcus. The patient later developed acute respiratory failure from diffuse alveolar hemorrhage (DAH). Subacute infective endocarditis can result in serious morbidity and mortality due to its insidious symptoms and subsequent fatal complications.
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3
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Zhang W, Zhang H, Wu D, Fu H, Shi W, Xue F. Antineutrophil cytoplasmic antibody-positive infective endocarditis complicated by acute kidney injury: a case report and literature review. J Int Med Res 2020; 48:300060520963990. [PMID: 33078666 PMCID: PMC7583404 DOI: 10.1177/0300060520963990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022] Open
Abstract
Patients with infective endocarditis (IE) may present with multisystem disturbances resembling autoimmune diseases, such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The kidneys are susceptible to damage in IE and AAV, which is a source of diagnostic ambiguity. Therefore, distinguishing infection from an inflammatory process is pivotal for guiding appropriate therapy. We report a 22-year-old man with IE characterized by ANCA positivity and complicated by acute kidney injury. A renal biopsy showed crescentic nephritis with tubulointerstitial lesions. However, transthoracic echocardiography and blood culture provided evidence of IE, and AAV was ruled out. Surgical intervention and antibiotic treatments were successful. We summarized previously reported cases of ANCA-positive IE that had renal biopsy data. We found that ANCA-positive IE can involve multiple organs. The representative renal pathology was crescentic nephritis, focal segmental glomerulonephritis, mesangial cell proliferation, tubular injury, and interstitial oedema. Immunofluorescence showed predominate C3 deposits. Electron microscopy showed electron-dense deposits in the subendothelial or mesangial areas. Eight patients received immunosuppressive therapy with excellent results. Repeated testing for bacterial pathogens and multiple renal biopsies may be useful for diagnosing ANCA-positive IE. With ANCA-positive IE, immunosuppressive therapy along with antibiotic treatments may be beneficial for recovery of renal function.
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Affiliation(s)
- Wei Zhang
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hui Zhang
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Daoxu Wu
- Department of Nephrology, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, Shandong, China
| | - Haiyang Fu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weiping Shi
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Feng Xue
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Lactobacillus acidophilus Endocarditis Complicated by Pauci-Immune Necrotizing Glomerulonephritis. Case Rep Med 2020; 2020:1607141. [PMID: 32849876 PMCID: PMC7441411 DOI: 10.1155/2020/1607141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/09/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022] Open
Abstract
Infective endocarditis (IE) is more common in patients with predisposing cardiac lesions and has many potential complications, including stroke and arterial thromboembolisms. Renal manifestations have an estimated prevalence of ∼20%. Rapidly progressive glomerulonephritis (RPGN) is a nephrological emergency manifested by autoimmune-mediated progressive loss of renal function over a relatively short period of time. Here, we report the case of a 60-year-old Caucasian male, who presented with speech impairment and was found to have multiple embolic strokes caused by aortic valve IE. His renal function declined rapidly, and his urine sediment featured hematuria and proteinuria. ANCA titer was negative by immunofluorescence (IF); however, the PR3 antibody was elevated. The renal biopsy revealed pauci-immune focally necrotizing glomerulonephritis with the presence of ∼25% cellular crescents. He was initially treated with plasmapheresis and pulse dose steroids. Hemodialysis was initiated for uremic symptoms. After four weeks of antibiotic therapy and with blood cultures remaining negative, he was treated with rituximab. Two months after discharge, his renal function showed improvement, and hemodialysis was discontinued. This case highlights several complications associated with lactobacillus endocarditis including RPGN.
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Shaik A, Roeuth D, Azmeen A, Thanikonda V, Guevara-Pineda D, Alamnajam M, Yamase H, Haider L. Granulicatella Causing Infective Endocarditis and Glomerulonephritis. IDCases 2020; 21:e00792. [PMID: 32489865 PMCID: PMC7256654 DOI: 10.1016/j.idcr.2020.e00792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022] Open
Abstract
Granulicatella is a type of nutritionally variant Streptococcus (NVS) that requires special medium for growth. It has shown to cause infective endocarditis which is associated with higher mortality and complications. We present a case of Granulicatella causing endocarditis and glomerulonephritis. There has only been one such prior case report. An adult male with a remote history of gastric bypass presented with shortness of breath with exertion, lower extremity swelling of 1-month duration. Blood cultures 4/4 bottles grew Granulicatella albicans with infected tooth being the source. Transesophageal echocardiogram revealed a vegetation on the mitral valve. He received intravenous vancomycin. He was found to have acute kidney injury requiring hemodialysis. Kidney biopsy revealed immune complex deposits in the mesangium and along the capillary basement membrane suggestive of post infectious glomerulonephritis. It is crucial to recognize NVS as potential cause for endocarditis in cultures that are slow growing. NVS require a special medium. Though it is rare, NSV can also cause glomerulonephritis. Early recognition is important to help with determining treatment options which may include immunosuppressive therapy along with treatment of underlying infection.
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Affiliation(s)
- Ayesha Shaik
- Internal Medicine, UConn Health Cente, Farmington CT, United States
| | - David Roeuth
- Internal Medicine, UConn Health Cente, Farmington CT, United States
| | - Ayesha Azmeen
- Internal Medicine, UConn Health Cente, Farmington CT, United States
| | | | | | - Mansour Alamnajam
- Department of Cardiology, UConn Health Center, Farmington, CT, United States
| | - Harold Yamase
- Department of Pathology, UConn Health Center, Farmington, CT, United States
| | - Lalarukh Haider
- Department of Nephrology, UConn Health Center, Farmington, CT, United States
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Plasmapheresis for treatment of immune complex-mediated glomerulonephritis in infective endocarditis: a case report and literature review. Clin Nephrol Case Stud 2017; 5:26-31. [PMID: 29043144 PMCID: PMC5438014 DOI: 10.5414/cncs109082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 57-year-old man who presented with subacute bacterial endocarditis secondary to Streptococcus mutans complicated by biopsy-proven immune complex-mediated glomerulonephritis (ICGN). Despite initial treatment with antibiotics and a short course of corticosteroids, the kidney function further deteriorated, and plasmapheresis was introduced as third-line therapy to remove circulating immune complexes. Following 7 treatment sessions, the patient recovered kidney function. We discuss the potential merit of plasmapheresis for patients with subacute bacterial endocarditis who develop ICGN.
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Krishnamurthy S, Chandrasekaran V, Mahadevan S, Priyamvada PS, Rajesh NG. Severe acute kidney injury in children owing to infective endocarditis-associated immune complex glomerulonephritis: a report of two cases. Paediatr Int Child Health 2017; 37:144-147. [PMID: 27077635 DOI: 10.1080/20469047.2015.1135562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Renal involvement in infective endocarditis (IE) may manifest with different clinical patterns, including diffuse proliferative glomerulonephritis and crescentic glomerulonephritis, which may lead to haematuria and/or proteinuria. However, severe acute kidney injury (AKI) in such cases is extremely uncommon and is reported mostly in adults. Two children with rheumatic heart disease and a peri-membranous ventricular septal defect, respectively, who developed haematuria, proteinuria and severe AKI in association with IE are reported. The first case had diffuse proliferative glomerulonephritis with 10% cellular crescents, and made a complete renal recovery with antibiotics and intravenous methylprednisolone followed by oral prednisolone. However, the second case had severe crescentic glomerulonephritis which led to residual renal injury despite intravenous methylprednisolone and cyclophosphamide in combination with antibiotics. The cases illustrate that crescentic glomerulonephritis or severe diffuse proliferative glomerulonephritis should be considered as possible complications in children presenting with haematuria, proteinuria and severe AKI. Renal biopsy along with antibiotic therapy and prompt immunosuppressive therapy should be considered for the management of this potentially life-threatening condition.
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Affiliation(s)
| | | | | | | | - Nachiappa Ganesh Rajesh
- c Pathology , Jawaharlal Institute of Postgraduate Medical Education and Research , Pondicherry , India
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Kutiyal AS, Daga MK. Ruptured Sinus of Valsalva with Infective Endocarditis Complicated with Post-Infectious Acute Glomerulonephritis: A Rare Case Presentation. J Clin Diagn Res 2016; 10:OD14-OD15. [PMID: 27891383 DOI: 10.7860/jcdr/2016/21220.8754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/16/2016] [Indexed: 11/24/2022]
Abstract
Ruptured Sinus of Valsalva (RSOV) is a rarely seen disease condition. RSOV can have varied presentations from being asymptomatic with just a cardiac murmur to profound hypotension. There has been simultaneous occurrence of RSOV with Infective Endocarditis (IE) in literature. Glomerulonephritis has also been reported in approximately 20% patients with IE. Large amount of proteinuria or decline in kidney functions is rarely encountered and mostly this finding has been incidental on routine evaluation. The co-existence of all the three conditions in a single patient is rare. This case was diagnosed to have RSOV with IE and was also diagnosed with post-infectious glomerulonephritis on renal biopsy. Patient was advised corrective cardiac surgery, but due to financial constraints, patient could not be operated and he died. Here, we report for the first time an unusual presence of both RSOV and sub-aortic membrane with IE complicated by glomerulonephritis.
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Affiliation(s)
- Aditya Singh Kutiyal
- Senior Resident, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
| | - Mradul Kumar Daga
- Director Professor, Department of Medicine, Maulana Azad Medical College and Lok Nayak Hospital , New Delhi, India
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Chatterjee K, Sen C. Immunosupression for patients of endocarditis with glomerulonephritis. Indian J Nephrol 2014; 24:199-200. [PMID: 25120306 PMCID: PMC4127848 DOI: 10.4103/0971-4065.132028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- K Chatterjee
- Department of Medicine, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Education and Research, Guru Gobind Singh Indraprastha University, New Delhi, India
| | - C Sen
- Department of Medicine, Medical College and Hospital, Kolkata, West Bengal, India
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