<i>Bartonella</i> endocarditis in a child with tetralogy of Fallot complicated by PR3‐ANCA positive serology, autoimmune hemolytic anemia, and acute kidney injury

Williams, James M.; Parimi, Manoj; Sutherell, Jamie S

doi:10.1002/ccr3.1589

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…The prevalence of microbial isolates from blood samples was significantly higher in patients with ANCA-positive infective endocarditis and in 90% of cases; the cause was streptococci [3]. Constitutional symptoms and elevated values of acute inflammatory reactants (CRP and ESR) have been reported in almost all patients with ANCA-positive infective endocarditis [2,3,[9][10][11]. However, due to the constitutive symptoms and different clinical manifestations, in addition to infective endocarditis and vasculitis, it is also necessary to think about other connective tissue diseases and antiphospholipid syndrome.…”

Section: Discussion/conclusionmentioning

confidence: 99%

A Patient with Subacute Bacterial Endocarditis and Positive PR3-ANCA: A Case Report and Literature Review

2023

Ann Case Report

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Patients with subacute bacterial endocarditis (SBE) may present with multisystem disorders mimicking autoimmune diseases, such as an antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV). In this report, we present a 72-year-old female patient with streptococcal SBE who developed multiple inflammatory abnormalities, including ANCA positivity, which was complicated by the occurrence of leukocytoclastic vasculitis, glomerulonephritis, acute myocardial infarction, heart failure, and subarachnoid haemorrhage. The patient had previously known mitral valve regurgitation. Repeated transthoracic echocardiography showed a floating lesion in the area of the mitral valve corresponding to chronic vegetation and confirmed the suspicion of SBE. Antibiotic treatment resulted in the decline of inflammatory parameters and complete recovery of renal function. Conservative treatment of acute myocardial infarction and neurorehabilitation were successful. Repeated ANCA tests were negative. Previously reported cases showed that ANCA-positive SBE could involve multiple organs. Distinguishing between AAV and SBE can sometimes be very difficult because of their clinical and serological similarities. Such a wide clinical presentation requires intensive monitoring of these patients. In conclusion, if systemic vasculitis is suspected, it is necessary to exclude diseases that mimic vasculitis, such as SBE.

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Section: Discussion/conclusionmentioning

confidence: 99%

A Patient with Subacute Bacterial Endocarditis and Positive PR3-ANCA: A Case Report and Literature Review

2023

Ann Case Report

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“…Similar to our two endocarditis cases, there have been at least 58 case reports documenting B. henselae infection-related glomerulonephritis presenting with a variety of clinical, laboratory, and histological features mimicking vasculitic glomerulonephritis including 12 cases published in the last 5 years. [25][26][27][28][29][30][31][32][33][34][35][36] One notable nonendocarditis case ended up losing a renal allograft as a result. 35 Diagnoses of bartonellosis in many of these cases were often made on incidental finding of concurrent culturenegative endocarditis, and in a significant number of cases, an earlier diagnosis could have avoided unnecessary immunosuppression, hence highlighting the need to consider Bartonella or endocarditis-related glomerulonephritis as a differential diagnosis in our population presenting with atypical features of glomerulonephritis or vasculitis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Manifestations Associated with Bartonella henselae Infection in a Tropical Region

Tay

Freeman

Baird

2021

The American Journal of Tropical Medicine and Hygiene

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Bartonella henselae is a zoonotic Gram-negative Bacillus associated with self-limited regional lymphadenopathy. In recent decades, an expanding spectrum of clinical manifestations has been described, in part, due to improved diagnostics. However, updated epidemiological data are sparse. We retrospectively reviewed the clinical features of 31 patients with B. henselae infection over 15 years from 2005 to 2019, in the tropical Top End of Australia. Our annual disease incidence of 1.3 cases per 100,000 population is lower than that in the national database surveillances in the United States, but the hospitalization incidence of 0.9 per 100,000 population in our region is higher than those reported in the literature, with an average length of stay of 9 days. Patients were more commonly male, aboriginal, and aged less than 14 years (median age: 7 years), living in a rural setting with presentation during our monsoon season. The disease spectrum included lymph node disease (74%), organ peliosis, endocarditis, cutaneous lesions, parapharyngeal abscess, parotitis, and neurologic and ocular syndromes. Lymph node disease was far commoner in children than the more serious systemic B. henselae infections associated with adults (P = 0.074). Although no deaths were reported, significant morbidities were observed. Two endocarditis cases presented with glomerulonephritis, and hematological and neurological features mimicking vasculitis, and consequently received immunosuppressants. One case was only diagnosed after representation with serial embolic strokes. Given the heterogeneity of disease manifestations with nonspecific symptoms and significant consequences, a timely and accurate diagnosis is needed to avoid unnecessary treatments or interventions.

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Antineutrophil cytoplasmic antibodies in infective endocarditis: a case report and systematic review of the literature

et al. 2022

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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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Bartonella endocarditis in a child with tetralogy of Fallot complicated by PR3‐ANCA positive serology, autoimmune hemolytic anemia, and acute kidney injury

Cited by 4 publications

References 11 publications

A Patient with Subacute Bacterial Endocarditis and Positive PR3-ANCA: A Case Report and Literature Review

A Patient with Subacute Bacterial Endocarditis and Positive PR3-ANCA: A Case Report and Literature Review

Clinical Manifestations Associated with Bartonella henselae Infection in a Tropical Region

Antineutrophil cytoplasmic antibodies in infective endocarditis: a case report and systematic review of the literature

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