Nine cases of subacute bacterial endocarditis (SBE) associated with anti-PR3 ANCA have been described in the literature to date. We describe 2 cases of SBE associated with dual ANCA positivity (anti-PR3 and anti-MPO ANCA.) To our knowledge, these are the first such reported cases. One case was associated with cutaneous vasculitis, and the second with predisposing factors for SBE. ANCA titers resolved or decreased in both during initial corticosteroid therapy for suspected vasculitis. Follow-up of these patients revealed no evidence of the common ANCA associations such as Wegener granulomatosis. Rheumatologists, if aware of ANCA association with SBE, can avoid inappropriate immunosuppressive treatments.
Scand J Rheumatology 14Letters to the editor 441
Sacroiliitis in Male Systemic Lupus Erythematous
Sir,We read with great interest Dr Nassonova's and colleague's article on "Sacroiliitis in male systemic lupus erythematosus", and we would like to offer some additional information drawn from our experience.Sacroiliac joints are not, as a rule, involved in connective tissue diseases. However, lupoid sacroarthropathy, an association of 'lupoid' syndromes with seronegative spondyloarthritic features, has been described (1, 2). In order to determine the prevalence of sacroiliitis (SI) in male patients with systemic lupus erythematosus (SLE) and its variants, 16 SLE male patients seen during the period 1980-83 were evaluated clinically and radiologically for the presence of SI. The duration of their illness varied from 8 months to 15 years. Seven patients were black, 9 white, and all but 4 were receiving steroids (1 to 60 mgldaily). Half of the patients had radiologic evidence of SI. Six patients had back pain, while 10 did not. Radiographic SI was present in 4 patients bilaterally (symptomatic-HLA-B27 negative) and in 4 unilaterally. Osteitis condensans ilii was present in 3 patients and aseptic bone necrosis of other joints in 3 patients with S1. Five asymptomatic patients had normal X-rays. No distinctive clinical or serologic SLE parameters were found to be associated with the presence or absence of SI. The observed frequency of SI in our SLE patients far exceeded the expected one.Underestimation of complaints on the part of physicians, genetic predisposition by either sharing common HLA types or close linkage disequilibriums, and finally direct or indirect involvement of sacroiliac joints by aseptic bone necrosis are some of the etiologic hypotheses.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.