Positive Cytoplasmic Antineutrophil Cytoplasmic Antigen with PR3 Specificity Glomerulonephritis in a Patient with Subacute Bacterial Endocarditis: Table 1.

Uh, Mitchell; McCormick, Iain A.; Kelsall, J.

doi:10.3899/jrheum.101322

Cited by 23 publications

(24 citation statements)

References 11 publications

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“…In our literature review, ANCA-positive patients with IE exhibited: isolated mitral (39%) or aortic (39%) valvular vegetations, and both mitral and aortic vegetation (18%). 9,51,52,57,59 Thus, in our ANCA-positive patients, we suggest that diagnosis of IE at later stage and immunosuppression (related to older age and marked weight loss) may have resulted into increased bacterial mitral and aortic colonization. Our data are relevant as they suggest that the presence of multiple valve involvement may be a predictive marker of IE rather than systemic vasculitis in ANCA-positive patients.…”

Section: Discussionmentioning

confidence: 67%

“…Our literature review, in fact, identified 24 case reports of documented ANCA-positive patients with IE exhibiting renal impairment. 11,24,37,39,40,42–45,47,48,50,51,54,57–59,61 Twenty-one of these latter patients underwent renal biopsy showing: extracapillary GN with immune deposits (N = 5), pauci-immune GN (N = 4), segmental and focal necrotizing GN (N = 4), endocapillary GN with immune deposits (N = 3), interstitial nephritis (N = 1), chronic sclerotic GN (N = 1), both pauci-immune GN and interstitial nephritis (N = 2), and both endocapillary GN and interstitial nephritis (N = 1). 11,24,37,39,40,42–45,47,48,50,51,54,57–59,61 Altogether, our data suggest that whether patients with ANCA-associated IE, develop commonly renal impairment, renal damage are nonspecific in these patients.…”

Section: Discussionmentioning

confidence: 99%

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Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

et al. 2016

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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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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

et al. 2016

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“…This observation, together with the strong association of GPA with PRTN3 (which encodes the autoantigen of PR3-ANCA) and with SERPINA1 (encoding α1-antitrypsin, the major system able to catabolise PR3), suggested a central role of the autoantigen in the generation of ANCA and in the pathogenesis of AAV. [17] Several environmental agents are known to predispose to or trigger AAV; among these are air pollutants (especially silica), infections ( Staphylococcus aureus and viral infections) [18, 19] and drugs (e.g. penicillamine, propylthiouracil, dapsone, cocaine adulterated with lemivasole) [20–23].…”

Section: Introductionmentioning

confidence: 99%

ANCA-associated vasculitis in childhood: recent advances

et al. 2017

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Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides are rare systemic diseases that usually occur in adulthood. They comprise granulomatosis with polyangiitis (GPA, Wegener’s), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome). Their clinical presentation is often heterogeneous, with frequent involvement of the respiratory tract, the kidney, the skin and the joints. ANCA-associated vasculitis is rare in childhood but North-American and European cohort studies performed during the last decade have clarified their phenotype, patterns of renal involvement and their prognostic implications, and outcome. Herein, we review the main clinical and therapeutic aspects of childhood-onset ANCA-associated vasculitis, and provide preliminary data on demographic characteristics and organ manifestations of an Italian multicentre cohort.

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“…A few cases of lung involvement in SBE have been reported. Lung injury is usually diagnosed as lung abscessation based on the clinical manifestations and a positive response to antibiotic therapy [2,10]. However, we must be aware that the lung may also be involved in SBE patients with positive ANCA, showing pathological changes indicative of alveolar capillaritis, as seen in our case.…”

Section: Discussionmentioning

confidence: 72%

Culture-negative subacute bacterial endocarditis masquerades as granulomatosis with polyangiitis (Wegener’s granulomatosis) involving both the kidney and lung

Peng

Chen

et al. 2012

BMC Nephrol

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BackgroundSubacute bacterial endocarditis (SBE) occasionally exhibits positive cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) of the anti-proteinase-3 (PR-3) type. Clinically, it mimics ANCA-associated vasculitis, such as Wegener's disease with glomerulonephritis. Lung abscesses are the most common manifestation of lung involvement. We herein report a case of culture-negative SBE strongly c-ANCA/PR3-positive accompanied by pulmonary involvement and glomerulonephritis. In this case, we took biopsies of both the lung and kidney, although renal biopsy is usually preferred over lung biopsy. The lung biopsy showed severe alveolar capillaritis, suggesting vasculitis consistent with polyangiitis. The renal biopsy revealed glomerulonephritis with a membranoproliferative pattern. To our knowledge, this is the first such reported case.Case presentationA 68-year-old Chinese male patient presented to our hospital with a fever, cough, chest pain, and recurrent peripheral edema. He had a past medical history significant for treated schistosomiasis 20 years previously. Physical examination revealed palpable purpura, mild hypertension, hepatosplenomegaly, and a holosystolic cardiac murmur (Levine 2/6). Echocardiography showed tricuspid valve vegetations with moderate to severe regurgitation. Serum c-ANCA/PR3 and cryoglobulin were strongly positive. Renal biopsy results indicated membranoproliferative glomerulonephritis with several crescents. Chest CT revealed multiple intraparenchymal and subpleural nodules, and lung biopsy showed polyangiitis. The patient’s ANCA titers, glomerulonephritis, and pulmonary injury all resolved after antibiotic therapy.ConclusionSBE may present with positive c-ANCA/PR3, multiple pulmonary nodules, pulmonary polyangiitis, and glomerulonephritis clinically mimicking granulomatosis with polyangiitis (Wegener's granulomatosis).

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Positive Cytoplasmic Antineutrophil Cytoplasmic Antigen with PR3 Specificity Glomerulonephritis in a Patient with Subacute Bacterial Endocarditis: Table 1.

Cited by 23 publications

References 11 publications

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

ANCA-associated vasculitis in childhood: recent advances

Culture-negative subacute bacterial endocarditis masquerades as granulomatosis with polyangiitis (Wegener’s granulomatosis) involving both the kidney and lung

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