Successful Treatment of Infectious Endocarditis Associated Glomerulonephritis Mimicking C3 Glomerulonephritis in a Case with No Previous Cardiac Disease

Abstract

We report a 42-year-old man with subacute infectious endocarditis (IE) with septic pulmonary embolism, presenting rapidly progressive glomerulonephritis and positive proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA). He had no previous history of heart disease. Renal histology revealed diffuse endocapillary proliferative glomerulonephritis with complement 3- (C3-) dominant staining and subendothelial electron dense deposit, mimicking C3 glomerulonephritis. Successful treatment of IE with valve plastic surgery gradually ameliorated hypocomplementemia and renal failure; thus C3 glomerulonephritis-like lesion in this case was classified as postinfectious glomerulonephritis. IE associated glomerulonephritis is relatively rare, especially in cases with no previous history of valvular disease of the heart like our case. This case also reemphasizes the broad differential diagnosis of renal involvement in IE.

Antineutrophil cytoplasmic antibody-positive infective endocarditis complicated by acute kidney injury: a case report and literature review

“…We used the title and abstract entries “endocarditis” and “ANCA or antineutrophil cytoplasmic antibody” and “renal biopsy,” which yielded 26 well documented cases (English language only). 4 – 28 We added our case to this review and compared clinical features, pathology findings, treatment, and prognosis ( Tables 1, 2 ).…”

Vasculitides and glomerulonephritis associated withStaphylocococcus aureusinfective endocarditis: cases reports and mini-review of the literature

“…All cases selected for review except one [17] described clinical symptoms occurringbefore or during initial antibiotics treatment, like those we reported. This temporal relationship and the favourable outcome with antibiotics (sometimes associated with surgery) but without immunosuppressive therapy [10,11,14,18,[20][21][22][23]26,28] constituted a strong argument for a physiopathological link between Staphylococcus aureus IE and autoimmune process in the majority of cases. Conversely, the case reported by Hellmich and colleagues [17] described a microscopic polyangiitis occurring long after the end of antibiotics previously prescribed for Staphylococcus aureus IE.…”

“…For these cases of autoimmune process associated with IE [8][9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], glomerulonephritis were more frequently reported than vasculitides in association with Staphylococcus aureus IE. Except kidney, organs that were more frequently affected by vasculitis process were skin, gastrointestinal tract (suggested by abdominal pain like the first case we reported) and peripheral nerve.…”

“…the 18.3% rate (20 out of 109 cases) observed by Mahr and colleagues in a study focussing on the seroprevalence of ANCA in definite IE [42]. When ANCA were evidenced, organs involved were mainly kidney [17,19,21,24,25,28] and anecdotally peripheral nerve and lung [19,21].…”

“…The most commonly observed pattern in Kidney biopsy of glomerulonephritis associated with Staphylococcus aureus IE was membranoproliferative glomerulonephritis with endocapillary proliferation sometimes associated with extra capillary crescents, whether or not ANCA were evidenced [8][9][10][11][12]15,20,22,26,28]. In such cases with available data [9][10][11][12]20,22,28], deposits were made mainly of C3, IgA and/or IgG. These histopathological patterns (membranoproliferative glomerulonephritis with endocapillary proliferation sometimes associated with extra capillary crescents and C3, IgA and/or IgG deposits) were closer to those observed during all kind of Staphylococcus aureus infections [43] than those observed during IE [44].…”