Necrotizing ANCA-Positive Glomerulonephritis Secondary to Culture-Negative Endocarditis

Abstract

Infective endocarditis (IE) and small-vessel vasculitis may have similar clinical features, including glomerulonephritis. Furthermore the association between IE and ANCA positivity is well documented, making differential diagnosis between IE- and ANCA-associated vasculitis particularly difficult, especially in case of culture-negative IE. We report on one patient with glomerulonephritis secondary to culture-negative IE caused by Bartonella henselae which illustrates this diagnostic difficulty.

C-ANCA-positive glomerulonephritis associated with subacute infective endocarditis caused by Bartonella infection

“…Haare Heijmeijer et al [12]. However, this patient diagnosed to Bartonella IE lately after steroid and cyclophosphamide therapy for idiopathic ANCA-associated GN without antibiotics.…”

“…Among the extra-cardiac manifestations associated with IE, renal involvement occurs in about 40-50% of patients [12]. The causes of kidney disease include acute pyelonephritis, abscess formation from septic emboli, immune complex-mediated GN, ANCA-associated GN, and acute tubular necrosis or acute interstitial nephritis arising from renal toxicity caused by antibiotic treatment [12].…”

Diagnostic and treatment challenge of unrecognized subacute bacterial endocarditis associated with ANCA-PR3 positive immunocomplex glomerulonephritis: a case report and literature review

“…Similarly, a review of case reports on ANCA-positive patients with infectious endocarditis-associated GN reported various histological patterns of GN in renal biopsy, such as extracapillary GN with immune deposits, segmental and focal necrotizing GN, endocapillary GN with immune deposits, interstitial nephritis, chronic sclerotic GN, and both endocapillary GN and interstitial nephritis [8]. Although most patients had detectable immune deposits, C3 being most prominent, pauci-immune GN in patients with PR3-ANCA bacterial endocarditis has also been observed [15,16]. Taken together, although the histological appearance of infectious endocarditis-associated GN shows great variability, it is important to take into consideration that immune deposits usually indicate infection-related GN, regardless of ANCA positivity.…”

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

“…In one case, B. henselae was confused with a granulomatosis with polyangiitis (GPA) due to elevated c‐ANCA and anti‐PR3 antibody in a 28‐year‐old with endocarditis of a bicuspid aortic valve 1. Further, this organism has been identified as the causative agent in a growing number of cases of PR3‐ANCA positive subacute bacterial endocarditis (SBE) with accompanying glomerulonephritis 2, 3, 4, 5. Although hematologic manifestations are rare, generalized Bartonella infection has induced an autoimmune hemolytic anemia in at least one case 6.…”

“…1 Further, this organism has been identified as the causative agent in a growing number of cases of PR3-ANCA positive subacute bacterial endocarditis (SBE) with accompanying glomerulonephritis. [2][3][4][5] Although hematologic manifestations are rare, generalized Bartonella infection has induced an autoimmune hemolytic anemia in at least one case. 6 Considering Bartonella's association with PR3-ANCA positive infective endocarditis (IE), other immune-mediated syndromes could accompany this infection.…”