Double ANCA-positive vasculitis in a patient with infective endocarditis

Veerappan, Ilangovan; Prabitha, EN; Abraham, Arun; Theodore, Sanjay; Abraham, Georgi

doi:10.4103/0971-4065.106057

Cited by 15 publications

(10 citation statements)

References 8 publications

(9 reference statements)

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“…Several infections, including IE, cause positive ANCA tests by indirect immunofluorescence but negative ELISA testing. Our patient presented with positive p-ANCA (by ELISA); thus, this finding was most probable because of an AAV 1,11 . Glomerulonephritis is the most frequent histological finding in this type of vasculitis; however, some cases may consist of interstitial nephritis without glomerular involvement, as shown in this patient 12 .…”

Section: Discussionmentioning

confidence: 63%

Infective endocarditis due to Bartonella bacilliformis associated with systemic vasculitis: a case report

Peñafiel-Sam

Alarcón-Guevara

Chang-Cabanillas

et al. 2017

Rev. Soc. Bras. Med. Trop.

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Infective endocarditis due to Bartonella bacilliformis is rare. A 64-year-old woman, without previous heart disease, presented with 6 weeks of fever, myalgias, and arthralgias. A systolic murmur was heard on the tricuspid area upon examination, and an echocardiogram showed endocardial lesions in the right atrium. Bartonella bacilliformis was isolated in blood cultures, defining the diagnosis of infective endocarditis using Duke's criteria. Subsequently, the patient developed clinical and laboratory features compatible with antineutrophil cytoplasmic antibody-associated vasculitis. This case presents an uncommon complication of B. bacilliformis infection associated with the development of systemic vasculitis.

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Section: Discussionmentioning

confidence: 63%

Infective endocarditis due to Bartonella bacilliformis associated with systemic vasculitis: a case report

Peñafiel-Sam

Alarcón-Guevara

Chang-Cabanillas

et al. 2017

Rev. Soc. Bras. Med. Trop.

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“…La literatura recoge 16 casos de ANCA positivos en pacientes con endocarditis y glomerulonefritis aguda en biopsia renal (Tabla 1), de los cuales diez son ANCA anti-PR3 positivos [5][6][7][8][9][10][11][12][13] , dos anti-mieloperoxidasa 11,14 y en cinco de ellos no se especifica el tipo [15][16][17][18][19] . Los ANCA anti-PR3 se pueden elevar en enfermedades del tejido conectivo e infecciones crónicas como endocarditis subagudas bacterianas, tuberculosis o infección por el virus de la hepatitis B o C 5 , así como en ancianos.…”

Section: Discussionunclassified

Glomerulonefritis rápidamente progresiva asociada a endocarditis afebril y anca anti-proteinasa 3

Rodriguez

Zambrano

Cadiñanos

et al. 2017

Rev. Colomb. Nefrol.

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Resumen La endocarditis asociada a ANCA anti-PR3 e insuficiencia renal plantea un dilema tanto en su diagnóstico como tratamiento. Para abordar una revisión de dicho tema, se presenta el caso de un paciente con glomerulonefritis rápidamente progresiva secundaria a endocarditis subaguda por Enterococcus faecalis y positividad para ANCA anti-PR3. El diagnóstico diferencial principal se establecería entre una afectación renal de una vasculitis asociada a ANCA no diagnosticada previamente vs una glomerulonefritis postinfecciosa secundaria a la endocarditis. En muchos casos es necesario disponer de una biopsia renal que esclarezca el diagnóstico, ya que una inmunofluorescencia negativa orientará hacia una vasculitis, mientras que una positividad para inmunocomplejos iría a favor de una glomerulonefritis postestreptocócica. El tratamiento a seguir es otro reto que se plantea en la coexistencia de insuficiencia renal aguda, endocarditis y ANCA anti-PR3 positivo. La positividad de ANCAs induce a valorar iniciar tratamiento con inmunosupresores, no obstante, en el lecho de una endocarditis puede resultar desaconsejado e incluso poner en riesgo la vida del paciente someterlo a un estado de inmunosupresión. Es, por tanto, controvertido el uso de inmunosupresión en combinación con antibioterapia en el proceso agudo en contraposición al uso de antibioterapia exclusivamente. En el actual artículo se recogen los 19 casos publicados en la literatura de endocarditis asociados a ANCA anti-PR3, así como el tratamiento que se realizó en cada uno de los casos y la evolución en la función renal de cada paciente, concluyendo, en general, una mejor recuperación de la función renal en los pacientes tratados con antibioterapia en exclusiva que en aquellos tratados con la combinación antibiótico-corticoides. Sin embargo, dado el pequeño tamaño muestral, no se puede considerar significativa la diferencia entre ambos tratamientos. Absctrat Endocarditis associated with antiPR3 ANCA and acute kidney injure generates a challenge in its diagnosis and treatment. In order to make a review about that combination, we presented a patient with necrotizing glomerulonephritis produced by a Enterococcus faecalis´s subacute endocarditis and antiPR3 ANCA positive. Differential diagnosis is made between an acute kidney failure produced by ANCA´s vasculitis vs necrotizing glomerulonephritis by endocarditis. Frequently it is necessary to make a biopsy to get a diagnosis. Negative immunofluorescence will guide to vasculitis associated ANCA, while positive immune complexes will guide to poststreptococcal glomerulonephritis. Other challenge that generates the association of acute kidney disease, endocarditis and antiPR3 ANCA is the treatment. ANCA positive can prompt to start immunosuppressant treatments. However, in the context of endocarditis, it could be inadvisable and even dangerous to use it. For this reason, it is controversial the use of immunosuppressant in combination with antibiotics in the acute process, in contrast with the use of only antibiotics....

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“…A literature search of previously published cases concerning ANCA induction in infective endocarditis was performed via PubMed and Medline using the title and abstract entries “endocarditis” and “ANCA or antineutrophil cytoplasmic antibody,” yielding 70 relevant cases [ 1 , 5 – 39 ]. A recent publication by Ying et al (2014) describes 13 of these cases in addition to a literature review of several other ones [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Less frequently, ANCA induction can occur due to infections such as amebiasis, endocarditis, tuberculosis, malaria, human immunodeficiency virus infection, and hepatitis C virus (HCV) infection [ 2 , 4 ]. Because autoimmune and infectious diseases may present similarly, ANCA positivity must be carefully interpreted [ 5 ]. The following case describes a 43-year-old male with chronically untreated HCV infection who was admitted to hospital with infective endocarditis and was found to be c-ANCA positive.…”

Section: Introductionmentioning

confidence: 99%

Antineutrophil Cytoplasmic Antibody Induction due to Infection: A Patient with Infective Endocarditis and Chronic Hepatitis C

Kamar

Hawkins

2016

Canadian Journal of Infectious Diseases and Medical Microbiolog

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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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Double ANCA-positive vasculitis in a patient with infective endocarditis

Cited by 15 publications

References 8 publications

Infective endocarditis due to Bartonella bacilliformis associated with systemic vasculitis: a case report

Infective endocarditis due to Bartonella bacilliformis associated with systemic vasculitis: a case report

Glomerulonefritis rápidamente progresiva asociada a endocarditis afebril y anca anti-proteinasa 3

Antineutrophil Cytoplasmic Antibody Induction due to Infection: A Patient with Infective Endocarditis and Chronic Hepatitis C

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