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Antineutrophil cytoplasmic antibodies in infective endocarditis: a case report and systematic review of the literature. Clin Rheumatol 2022; 41:2949-2960. [PMID: 35732985 PMCID: PMC9485185 DOI: 10.1007/s10067-022-06240-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
Infective endocarditis (IE) may be misdiagnosed as ANCA-associated vasculitis (AAV), especially when antineutrophil cytoplasmic antibodies (ANCA) are detected. Distinguishing IE from AAV is crucial to guide therapy. However, little is known about ANCA positivity in IE patients. We present a case report and systematic review of the literature on patients with ANCA-positive IE, aiming to provide a comprehensive overview of this entity and to aid clinicians in their decisions when encountering a similar case. A systematic review of papers on original cases of ANCA-positive IE without a previous diagnosis of AAV was conducted on PubMed in accordance with PRISMA-IPD guidelines. A predefined set of clinical, laboratory, and kidney biopsy findings was extracted for each patient and presented as a narrative and quantitative synthesis. A total of 74 reports describing 181 patients with ANCA-positive IE were included (a total of 182 cases including our own case). ANCA positivity was found in 18-43% of patients with IE. Patients usually presented with subacute IE (73%) and had positive cytoplasmic ANCA-staining or anti-proteinase-3 antibodies (79%). Kidney function was impaired in 72%; kidney biopsy findings were suggestive of immune complexes in 59%, while showing pauci-immune glomerulonephritis in 37%. All were treated with antibiotics; 39% of patients also received immunosuppressants. During follow-up, 69% of patients became ANCA-negative and no diagnosis of systemic vasculitis was reported. This study reviewed the largest series of patients with ANCA-positive IE thus far and shows the overlap in clinical manifestations between IE and AAV. We therefore emphasize that clinicians should be alert to the possibility of an underlying infection when treating a patient with suspected AAV, even when reassured by ANCA positivity. Key Points • This systematic review describes - to our knowledge - the largest series of patients with ANCA-positive infective endocarditis (IE) thus far (N=182), and shows a high degree of overlap in clinical manifestations between IE and ANCA-associated vasculitis (AAV). • ANCA positivity was found in 18-43% of patients with infective endocarditis. Of patients with ANCA-positive IE, the majority (79%) showed cytoplasmic ANCA-staining or anti-PR3-antibodies. We emphasize that clinicians should be alert to the possibility of an underlying infection when treating a patient with suspected AAV, even when reassured by ANCA positivity. • In patients with IE and ANCA-associated symptoms such as acute kidney injury, an important clinical challenge is the initiation of immunosuppressive therapy. All patients with data in this series received antibiotics; 39% also received immunosuppressive therapy. In many of these patients, ANCA-associated symptoms resolved or stabilized after infection was treated. ANCA titers became negative in 69% , and a diagnosis of AAV was made in none of the cases. We therefore recommend that (empiric) antibiotic treatment remains the therapeutic cornerstone for ANCA-positive IE patients, while a watchful wait-and-see approach with respect to immunosuppression is advised.
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Golas VL, Lao KM, Misuraca MS, Li W, Marrone MG, Kanaan HD, Zhang PL. The clinical features of overlap syndrome (ANCA-associated crescentic glomerulonephritis [AACGN] and immune complex-mediated glomerulonephritis) are similar to those of AACGN alone. Int Urol Nephrol 2020; 53:515-521. [PMID: 33025405 DOI: 10.1007/s11255-020-02654-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/14/2020] [Indexed: 12/01/2022]
Abstract
The overlap syndromes of anti-neutrophil cytoplasmic antibodies (ANCA)-associated crescentic glomerulonephritis (AACGN) and variants of immune complex medicated glomerulopathy (ICMGN) have been reported. But very few have compared AACGN alone with the overlap syndromes (AACGN plus ICMGN). The aim of this retrospective study was to make that comparison, following serum creatinine (sCr) to determine whether the two groups (AACGN-only group versus overlap group) would behave differently over time. We identified 14 cases with dual diagnoses of AACGN and various ICMGN in the overlap group. Data were collected and compared with 15 randomly selected AACGN-only cases over the similar period of time. The overlap syndrome represented 0.35% of our overall biopsies (14/4049). All 14 patients were ANCA positive and had crescentic formation. The percentage of crescents in the biopsies ranged from 10 to 78%. ICMGN included the following: membranoproliferative glomerulonephritis, post-infectious glomerulonephritis, membranous glomerulopathies, idiopathic mesangial proliferative glomerulonephritis, lupus nephritis, and IgA nephropathy. With the exception one biopsy revealing lupus nephritis class III, most of the ICMGN were mild. When compared to the AACGN-only group, there were no significant differences in clinical and histologic indices including age, percent of crescents, and sCr (on biopsy days, and over the follow-up periods), although the numbers of follow-up cases were limited over time. Our findings suggest that AACGN was the dominant disease process in the majority of overlap syndromes between AACGN and ICMGN, similar to the clinical processes of AACGN-only disease, therefore, the AACGN in overlap syndrome cases should be the main target for clinical management.
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Affiliation(s)
- Victoria L Golas
- Department of Nephrology, Beaumont Health System, Farminton Hill Campus, Southfield, MI, USA
| | - Kriselle Maris Lao
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA
| | - Michael S Misuraca
- Department of Nephrology, Beaumont Health System, Farminton Hill Campus, Southfield, MI, USA
| | - Wei Li
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA
| | - Mark G Marrone
- Department of Nephrology, Beaumont Health System, Farminton Hill Campus, Southfield, MI, USA
| | - Hassan D Kanaan
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA
| | - Ping L Zhang
- Department of Pathology, Royal Oak Campus, Beaumont Health System, Southfield, MI, USA. .,Division of Anatomic Pathology, William Beaumont Hospital, Beaumont LaboratoryRoyal Oak, MI, 48073, USA.
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Tauseef A, Asghar MS, Amir M, Zafar M, Anum A, Alvi H, Dawood M, Rasheed U, Akram M, Ahmed N. Microscopic polyangiitis: an incidental finding in a patient with stroke. J Community Hosp Intern Med Perspect 2020; 10:50-54. [PMID: 32128059 PMCID: PMC7034484 DOI: 10.1080/20009666.2020.1718479] [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: 09/13/2019] [Accepted: 12/30/2019] [Indexed: 10/31/2022] Open
Abstract
Microscopic polyangiitis (MPA) is a primary systemic vasculitis characterized by inflammation
of small-sized vessels associated with the presence of anti-neutrophilic cytoplasmic
antibodies. We report a case of a 39-year-old female diagnosed with microscopic polyangiitis as
an incidental finding who presented with signs and symptoms of a stroke at a young age.
Usually, it presents with fever, malaise, skin rash, weight loss, mononeuritis multiplex, and
arthralgia/myalgia. Very rarely, it can involve meninges to cause meningeal vasculitis which
can present as a febrile seizure. The most frequent neurological manifestation is peripheral
neuropathy. Cerebral infarction or hemorrhage as an isolated finding is very rarely observed in
the patient with MPA as was seen in our patient.
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Affiliation(s)
- Abubakar Tauseef
- Internal Medicine, Dow University Hospital, DUHS, Karachi, Pakistan
| | | | - Mariam Amir
- Internal Medicine, Dow University Hospital, DUHS, Karachi, Pakistan
| | - Maryam Zafar
- Internal Medicine, Dow University Hospital, DUHS, Karachi, Pakistan
| | - Ayesha Anum
- Internal Medicine, Dow University Hospital, DUHS, Karachi, Pakistan
| | - Haris Alvi
- Medicine, Dow University Hospital, DUHS, Karachi, Pakistan
| | - Mustafa Dawood
- Internal Medicine, Greater Baltimore Medical Center, Towson, MD, USA
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Mohammed Akram
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Nisar Ahmed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
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Bornstein G, Ben-Zvi I, Furie N, Grossman C. Clinical significance of positive anti-neutrophil cytoplasmic antibodies without evidence of anti-neutrophil cytoplasmic antibodies-associated vasculitis. Int J Rheum Dis 2019; 22:940-945. [PMID: 30729688 DOI: 10.1111/1756-185x.13483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 11/07/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Abstract
AIM Anti-neutrophil cytoplasmic antibodies (ANCA) have a role in the diagnostic workup of ANCA-associated vasculitis. However, the clinical significance of positive ANCA in the absence of vasculitis is yet to be determined. Therefore, we sought to investigate the clinical spectrum and rate of patients with a positive ANCA without evidence of vasculitis. METHODS Retrospective analysis of patients positive for cytoplasmic ANCA (C-ANCA) and proteinase 3 (PR3) or P-ANCA and myeloperoxidase (MPO) between 2007 and 2016 in the Chaim Sheba Medical Center, Israel. The proportion of patients who had no evidence of vasculitis among all patients with a positive C-ANCA/PR3 or P-ANCA/MPO was calculated according to tertiles of enzyme-linked immunosorbent assay (ELISA) antibody levels. RESULTS Among 113 patients who tested positive for C-ANCA/PR3 or P-ANCA/MPO, 68 (60.1%) had no evidence of vasculitis. ELISA antibody titers were significantly higher among patients with vasculitis than those without (6.2 vs 3.2, for C-ANCA/PR3 and 5.4 vs 2.6 for P-ANCA/MPO, P < 0.05). The proportion of patients without vasculitis among all patients with a positive C-ANCA/PR3 and among all patients with a positive P-ANCA/MPO declined in parallel to the increases in ELISA antibody level tertiles (96%, 57% and 22% in the 1st, 2nd and highest tertiles, respectively, for patients with C-ANCA/PR3 patients and 100%, 66% and 20% in the 1st, 2nd and highest tertiles, respectively, for patients with P-ANCA/MPO). CONCLUSION A significant proportion of patients with a positive C-ANCA/PR3 or P-ANCA/MPO do not have evidence of vasculitis, particularly those with low-medium ELISA antibody titers. Using a higher threshold of ANCA titers may be required to improve specificity.
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Affiliation(s)
- Gil Bornstein
- Department of Internal Medicine B and the Rheumatology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Ben-Zvi
- Department of Internal Medicine F and the Rheumatology Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nadav Furie
- Department of Internal Medicine F and the Rheumatology Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Chagai Grossman
- Department of Internal Medicine F and the Rheumatology Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Langlois V, Marie I. Endocardites infectieuses associées aux anticorps anticytoplasme des polynucléaires neutrophiles (ANCA) : revue de la littérature. Rev Med Interne 2017; 38:450-457. [DOI: 10.1016/j.revmed.2016.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/15/2016] [Accepted: 12/26/2016] [Indexed: 12/19/2022]
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Jankovic A, Maslarevic-Radovic V, Djuric P, Tosic-Dragovic J, Bulatovic A, Simovic N, Mitrovic M, Stankovic-Popovic V, Dopudja-Pantic V, Arandjelovic S, Dimkovic N. Onset of Microscopic Polyangiitis in Binephrectomied Patient on Chronic Hemodialysis-Case Report. Front Immunol 2017; 8:111. [PMID: 28243232 PMCID: PMC5303727 DOI: 10.3389/fimmu.2017.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 01/24/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Microscopic polyangiitis (MPA) is one of the causes of the pulmonary–renal syndrome associated with elevated non-specific markers of inflammation and antineutrophil cytoplasmic autoantibody (ANCA) positivity in 50–75%. De novo occurrence of the disease in patients on chronic hemodialysis (HD) has not been described. Case presentation We presented patient who developed MPO-ANCA-associated MPA with lung and musculoskeletal involvement after 4 years on regular HD due to bilateral nephrectomy. After excluding the other causes of MPO-ANCA positivity, diagnosis was confirmed even without renal biopsy. Patient received standard immunosuppression therapy and he is still in remission after 27 months. Conclusion The onset of immune-mediated disease could be observed even after introduction of renal replacement therapy, which may be a diagnostic problem. Early recognition and traditional immunosuppressive regiment may provide successful outcome.
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Affiliation(s)
- Aleksandar Jankovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Vesna Maslarevic-Radovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Petar Djuric
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Jelena Tosic-Dragovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Ana Bulatovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Nikola Simovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Milos Mitrovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Verica Stankovic-Popovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara , Belgrade , Serbia
| | - Vesna Dopudja-Pantic
- Clinical Department for Pulmonology, University Medical Center Zvezdara , Belgrade , Serbia
| | - Snezana Arandjelovic
- Institute for Allergology and Immunology, Clinical Center Serbia , Belgrade , Serbia
| | - Nada Dimkovic
- Clinical Department for Nephrology with Dialysis, University Medical Center Zvezdara, Belgrade, Serbia; Medical Faculty, Belgrade University, Belgrade, Serbia
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Antineutrophil Cytoplasmic Antibody Induction due to Infection: A Patient with Infective Endocarditis and Chronic Hepatitis C. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:3585860. [PMID: 27366166 PMCID: PMC4904576 DOI: 10.1155/2016/3585860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
While antineutrophil cytoplasmic antibody (ANCA) is often used as a diagnostic marker for certain vasculitides, ANCA induction in the setting of infection is much less common. In the case of infective endocarditis, patients may present with multisystem disturbances resembling an autoimmune process, cases that may be rendered even trickier to diagnose in the face of a positive ANCA. Though not always straightforward, distinguishing an infective from an inflammatory process is pivotal in order to guide appropriate therapy. We describe an encounter with a 43-year-old male with chronically untreated hepatitis C virus infection who featured ANCA positivity while hospitalized with acute bacterial endocarditis. His case serves as a reminder of two of the few infections known to uncommonly generate ANCA positivity. We also summarize previously reported cases of ANCA positivity in the context of endocarditis and hepatitis C infections.
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Langlois V, Lesourd A, Girszyn N, Ménard JF, Levesque H, Caron F, Marie I. Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis. Medicine (Baltimore) 2016; 95:e2564. [PMID: 26817911 PMCID: PMC4998285 DOI: 10.1097/md.0000000000002564] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/17/2015] [Accepted: 12/28/2015] [Indexed: 12/23/2022] Open
Abstract
To determine the prevalence of antineutrophil cytoplasmic antibodies (ANCA) in patients with infective endocarditis (IE) in internal medicine; and to compare clinical and biochemical features and outcome between patients exhibiting IE with and without ANCA.Fifty consecutive patients with IE underwent ANCA testing. The medical records of these patients were reviewed.Of the 50 patients with IE, 12 exhibited ANCA (24%). ANCA-positive patients with IE exhibited: longer duration between the onset of first symptoms and IE diagnosis (P = 0.02); and more frequently: weight loss (P = 0.017) and renal impairment (P = 0.08), lower levels of C-reactive protein (P = 0.0009) and serum albumin (P = 0.0032), involvement of both aortic and mitral valves (P = 0.009), and longer hospital stay (P = 0.016). Under multivariate analysis, significant factors for ANCA-associated IE were: longer hospital stay (P = 0.004), lower level of serum albumin (P = 0.02), and multiple valve involvement (P = 0.04). Mortality rate was 25% in ANCA patients; death was because of IE complications in all these patients.Our study identifies a high prevalence of ANCA in unselected patients with IE in internal medicine (24%). Our findings further underscore that ANCA may be associated with a subacute form of IE leading to multiple valve involvement and more frequent renal impairment. Because death was due to IE complications in all patients, our data suggest that aggressive therapy may be required to improve such patients' outcome.
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Affiliation(s)
- Vincent Langlois
- From the Department of Internal Medicine, Institute for Biochemical Research, IFRMP, University of Rouen (VL, AL, NG, HL, IM); Department of Infectious diseases (FC); and Department of Biostatistics (J-F M), CHU Rouen, France
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Renal involvements in reported cases of Streptococcus bovis endocarditis. Int J Cardiol 2014; 181:179. [PMID: 25528307 DOI: 10.1016/j.ijcard.2014.11.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/23/2014] [Indexed: 11/22/2022]
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Khalighi MA, Nguyen S, Wiedeman JA, Palma Diaz MF. Bartonella Endocarditis–Associated Glomerulonephritis: A Case Report and Review of the Literature. Am J Kidney Dis 2014; 63:1060-5. [DOI: 10.1053/j.ajkd.2013.10.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/23/2013] [Indexed: 11/11/2022]
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Infective endocarditis with antineutrophil cytoplasmic antibody: report of 13 cases and literature review. PLoS One 2014; 9:e89777. [PMID: 24587028 PMCID: PMC3934949 DOI: 10.1371/journal.pone.0089777] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/24/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chronic infections tend to induce the production of antineutrophil cytoplasmic antibody (ANCA). Infective endocarditis (IE) has been reported to exhibit positive ANCA tests and to mimic ANCA-associated vasculitis, which may lead to a misdiagnosis and inappropriate treatment. The aim of this study was to clarify whether there is any difference in the clinical features between ANCA-positive IE and ANCA-negative IE. METHODS A retrospective study was carried out on 39 IE patients whose proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA levels were measured. After dividing the patients into ANCA-positive and ANCA-negative IE, we compared their clinical features. RESULTS we compared 13 ANCA-positive IE patients with 26 ANCA-negative IE patients. All 13 ANCA-positive IE patients were proteinase-3-ANCA positive. Compared with the ANCA-negative IE group, the prevalence of edema of the lower extremities, the serum lactate dehydrogenase (LDH) level and positive blood cultures rate were higher in ANCA-positive IE group, but there was no significant difference in other clinical features. CONCLUSION Therefore, if a patient presents with fever, arthralgia, skin rash and is ANCA-positive, appropriate steps should be taken to exclude infection (especially IE) before confirming the diagnosis of ANCA-associated vasculitis and embarking on long-term immunosuppressive therapy.
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Rousseau-Gagnon M, Riopel J, Desjardins A, Garceau D, Agharazii M, Desmeules S. Gemella sanguinis endocarditis with c-ANCA/anti-PR-3-associated immune complex necrotizing glomerulonephritis with a 'full-house' pattern on immunofluorescence microscopy. Clin Kidney J 2013; 6:300-4. [PMID: 26064489 PMCID: PMC4400477 DOI: 10.1093/ckj/sft030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/26/2013] [Indexed: 01/23/2023] Open
Abstract
A 67-year-old man was evaluated for haematuria, with a rising creatinine level from 88 to 906 µmol/L and positive c-anti-neutrophil cytoplasm antibody (ANCA)/anti-proteinase 3 (anti-PR3). A kidney biopsy revealed necrotizing glomerulonephritis with a ‘full-house’ pattern on immunofluorescence microscopy. Echocardiography and blood cultures growing Gemella sanguinis diagnosed endocarditis. Dialysis was required for a month. Three months later, following valve replacement, glucocorticoids and 2 months of antibiotic therapy, the creatinine level decreased to 62 µmol/L and c-ANCA/anti-PR3 disappeared. This first case of c-ANCA/anti-PR3 positive glomerulonephritis with a ‘full-house’ immunofluorescence pattern due to bacterial endocarditis underlines the importance of ruling out infection with ANCA positivity or kidney biopsy suggestive of lupus nephritis.
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Affiliation(s)
| | - Julie Riopel
- Service of Pathology , CHUQ-Hôtel-Dieu de Québec , Quebec , Canada
| | - Anne Desjardins
- Service of Infectious Diseases , CHUQ-Hôtel-Dieu de Québec , Quebec , Canada
| | | | - Mohsen Agharazii
- Service of Nephrology , CHUQ-Hôtel-Dieu de Québec , Quebec , Canada
| | - Simon Desmeules
- Service of Nephrology , CHUQ-Hôtel-Dieu de Québec , Quebec , Canada
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Konstantinov KN, Emil SN, Barry M, Kellie S, Tzamaloukas AH. Glomerular disease in patients with infectious processes developing antineutrophil cytoplasmic antibodies. ISRN NEPHROLOGY 2013; 2013:324315. [PMID: 24959541 PMCID: PMC4045435 DOI: 10.5402/2013/324315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 12/21/2022]
Abstract
To identify differences in treatment and outcome of various types of glomerulonephritis developing in the course of infections triggering antineutrophil cytoplasmic antibody (ANCA) formation, we analyzed published reports of 50 patients. Immunosuppressives were added to antibiotics in 22 of 23 patients with pauci-immune glomerulonephritis. Improvement was noted in 85% of 20 patients with information on outcomes. Death rate was 13%. Corticosteroids were added to antibiotics in about 50% of 19 patients with postinfectious glomerulonephritis. Improvement rate was 74%, and death rate was 26%. Two patients with mixed histological features were analyzed under both pauci-immune and post-infectious glomerulonephritis categories. In 9 patients with other renal histology, treatment consisted of antibiotics alone (7 patients), antibiotics plus immunosuppressives (1 patient), or immunosuppressives alone (1 patient). Improvement rate was 67%, permanent renal failure rate was 22%, and death rate was 11%. One patient with antiglomerular basement disease glomerulonephritis required maintenance hemodialysis. Glomerulonephritis developing in patients who became ANCA-positive during the course of an infection is associated with significant mortality. The histological type of the glomerulonephritis guides the choice of treatment. Pauci-immune glomerulonephritis is usually treated with addition of immunosuppressives to antibiotics.
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Affiliation(s)
- Konstantin N. Konstantinov
- Division of Rheumatology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Suzanne N. Emil
- Division of Rheumatology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Marc Barry
- Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, BMSB, Room 335, University of New Mexico, Albuquerque, NM 87131, USA
| | - Susan Kellie
- Division of Infectious Diseases, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Antonios H. Tzamaloukas
- Division of Nephrology, Department of Medicine, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, VA Medical Center (111C), 1501 San Pedro, SE, Albuquerque, NM 87131, USA
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Nasr SH, Radhakrishnan J, D'Agati VD. Bacterial infection-related glomerulonephritis in adults. Kidney Int 2013; 83:792-803. [PMID: 23302723 DOI: 10.1038/ki.2012.407] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the past, most cases of bacterial infection-related glomerulonephritis (IRGN) occurred in children following streptococcal upper respiratory tract or skin infections and were called postinfectious GN. Over the past 3 decades, there has been an important shift in epidemiology, bacteriology, and outcome of IRGN. A significant percentage of cases now target adults, particularly the elderly or immunocompromised. Because adult infections are often ongoing at the time of diagnosis, the term IRGN appears more appropriate. The sites of infection in adult IRGN are more heterogeneous than in children, and include the upper respiratory tract, skin, lung, heart, urinary tract, teeth/oral mucosa, and bone. In adults, the disease is more likely to be secondary to non-streptococcal infections, particularly staphylococcal infection. In contrast to the favorable course in children, a significant proportion of adults with IRGN, especially the elderly and diabetics, do not recover renal function. Whereas the pathogenesis of post-streptococcal glomerulonephritis has been studied extensively, leading to the identification of two candidate nephritogenic streptococcal antigens, glyceraldehyde-3-phosphate dehydrogenase and pyrogenic exotoxin B, few investigations have focused on IRGN caused by other bacteria. This review will address the current status of sporadic bacterial IRGN in adults.
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Affiliation(s)
- Samih H Nasr
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Fukasawa H, Hayashi M, Kinoshita N, Ishigaki S, Isobe S, Sakao Y, Kato A, Fujigaki Y, Furuya R. Rapidly progressive glomerulonephritis associated with PR3-ANCA positive subacute bacterial endocarditis. Intern Med 2012; 51:2587-90. [PMID: 22989831 DOI: 10.2169/internalmedicine.51.8081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Patients with bacterial endocarditis often have renal complications. This report presents the case of an elderly man with rapidly progressive glomerulonephritis (RPGN) associated with subacute bacterial endocarditis (SBE) due to Enterococcus faecalis infection. The patient was positive for anti-proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) and rheumatoid factor (RF) with hypocomplementemia. Treatment for SBE with antibiotics and the surgical replacement of the affected valves resulted in an improvement of RPGN, the disappearance of PR3-ANCA and RF, and the normalization of hypocomplementemia. This rare case suggests the importance of recognizing the cause of positive PR3-ANCA, because SBE could be an occult cause of RPGN mimicking ANCA-associated vasculitis.
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Affiliation(s)
- Hirotaka Fukasawa
- Renal Division, Department of Internal Medicine, Iwata City Hospital, Japan.
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Hanf W, Serre JE, Salmon JH, Fabien N, Ginon I, Dijoud F, Trolliet P. Glomérulonéphrite rapidement progressive à ANCA révélant une endocardite infectieuse subaiguë. Rev Med Interne 2011; 32:e116-8. [PMID: 21277658 DOI: 10.1016/j.revmed.2010.12.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/19/2022]
Affiliation(s)
- W Hanf
- Service de néphrologie-dialyse et transplantation, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, Pierre-Bénite cedex, France.
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Wilczynska M, Khoo JP, McCann GP. Unusual extracardiac manifestations of isolated native tricuspid valve endocarditis. BMJ Case Rep 2010; 2010:2010/nov26_1/bcr1120092502. [PMID: 22798103 DOI: 10.1136/bcr.11.2009.2502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Isolated native tricuspid valve endocarditis (TVE) in non-intravenous drug users is a very rare condition. We describe an unusual presentation of Enterococcus faecalis TVE associated with spondylodiscitis, positive cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase-3 antibodies vasculitic rash in an otherwise healthy patient with no history of intravenous drug use or underlying cardiac abnormalities. A high index of clinical suspicion is required in patients presenting with unusual features and pyrexia of unknown origin. Simple tests including serial blood cultures and echocardiography may help to establish the correct diagnosis and commence appropriate treatment.
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Abstract
In 1923, Friedrich Wohlwill described two patients with a "microscopic form of periarteritis nodosa," which was distinct from the classical form. This disease, now known as microscopic polyangiitis (MPA), is a primary systemic vasculitis characterized by inflammation of the small-caliber blood vessels and the presence of circulating antineutrophil cytoplasmic antibodies. Typically, microscopic polyangiitis presents with glomerulonephritis and pulmonary capillaritis, although involvement of the skin, nerves, and gastrointestinal tract is not uncommon. Treatment of MPA generally requires use of a cytotoxic agent (such as cyclophosphamide) in addition to high-dose glucocorticoids. Recent research has focused on identifying alternate treatment strategies that minimize or eliminate exposure to cytotoxic agents. This article reviews the history, pathogenesis, clinical manifestations, and treatment of MPA.
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Respiratory Failure and Antineutrophil Cytoplasmic Antibody-Positive Vasculitis Associated With Rothia mucilaginosa Endovascular Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181d5e1bd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zeledon JI, McKelvey RL, Servilla KS, Hofinger D, Konstantinov KN, Kellie S, Sun Y, Massie LW, Hartshorne MF, Tzamaloukas AH. Glomerulonephritis causing acute renal failure during the course of bacterial infections. Histological varieties, potential pathogenetic pathways and treatment. Int Urol Nephrol 2008; 40:461-70. [PMID: 18247152 DOI: 10.1007/s11255-007-9323-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022]
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21
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Current World Literature. Curr Opin Nephrol Hypertens 2005. [DOI: 10.1097/01.mnh.0000172731.05865.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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