Symptomatic anti-neutrophil cytoplasmic antibody-positive disease complicating subacute bacterial endocarditis: to treat or not to treat?

Abstract

A 54-year-old man was diagnosed with Streptococcus mutans endocarditis of the mitral valve. Serological tests disclosed the presence of multiple autoantibodies including c-ANCA, anti-PR3 and anti-MPO. While the fever subsided with antibiotics, mental status and renal function deteriorated rapidly. Kidney biopsy revealed pauci-immune glomerulonephritis and acute eosinophilic interstitial nephritis. The abnormal clinical features improved rapidly after addition of corticosteroids and cyclophosphamide to the antibiotics. Immunosuppressive agents may be required in a fraction of the patients with infective endocarditis who develop ANCA and ANCA-mediated renal disease. Histological identification of the type of renal disease is imperative for the choice of the treatment.

• Authors: Konstantin N Konstantinov, Alexis A Harris, Michael F Hartshorne, Antonios H Tzamaloukas
• Journal: Case reports in nephrology and urology (Case Rep Nephrol Urol) Vol. 2 Issue 1 Pg. 25-32 (Jan 2012) ISSN: 1664-5510 [Electronic] Switzerland
• PMID: 23197952 (Publication Type: Case Reports)