Complements do not lie

Robert, Stefanie Christina; Forbes, Suzanne; Soleimanian, Surusch; Hadley, J

doi:10.1136/bcr.08.2011.4705.corr1

Cited by 10 publications

(4 citation statements)

References 30 publications

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“… 31 , 43 , 48 , 58 In this instance, we did not experience cases of ANCA-positive patients with IE related to Bartonella spp. On the contrary, in our literature review, we have noted an overrepresentation of IE related to Bartonella (mainly Bartonella henselae and Bartonella quintana ) in ANCA-positive patients 31 , 44 , 50 – 55 , 59 . Indeed, Aslangul et al 34 reported ANCA positivity in up to 60% of patients with Bartonella IE.…”

Section: Discussioncontrasting

confidence: 64%

“…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: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

et al. 2016

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“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

et al. 2020

J Int Med Res

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Patients with infective endocarditis (IE) may present with multisystem disturbances resembling autoimmune diseases, such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The kidneys are susceptible to damage in IE and AAV, which is a source of diagnostic ambiguity. Therefore, distinguishing infection from an inflammatory process is pivotal for guiding appropriate therapy. We report a 22-year-old man with IE characterized by ANCA positivity and complicated by acute kidney injury. A renal biopsy showed crescentic nephritis with tubulointerstitial lesions. However, transthoracic echocardiography and blood culture provided evidence of IE, and AAV was ruled out. Surgical intervention and antibiotic treatments were successful. We summarized previously reported cases of ANCA-positive IE that had renal biopsy data. We found that ANCA-positive IE can involve multiple organs. The representative renal pathology was crescentic nephritis, focal segmental glomerulonephritis, mesangial cell proliferation, tubular injury, and interstitial oedema. Immunofluorescence showed predominate C3 deposits. Electron microscopy showed electron-dense deposits in the subendothelial or mesangial areas. Eight patients received immunosuppressive therapy with excellent results. Repeated testing for bacterial pathogens and multiple renal biopsies may be useful for diagnosing ANCA-positive IE. With ANCA-positive IE, immunosuppressive therapy along with antibiotic treatments may be beneficial for recovery of renal function.

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“…Treatment with immunosuppressive medications may increase the risk of septic death [ 4 ]. Also, treatment of the endocarditis with appropriate antibiotics usually leads to abolition of the immunological abnormalities and their clinical manifestations [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Anti-Neutrophil Cytoplasmic Antibody-Positive Disease Complicating Subacute Bacterial Endocarditis: To Treat or Not to Treat?

Konstantinov

Harris

Hartshorne

et al. 2012

Case Rep Nephrol Urol

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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.

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Complements do not lie

Abstract: The spelling of the third author's name 'Surusch Soleimanian' is incorrect and the correct spelling should be 'Sorrush Soleimanian'.

Cited by 10 publications

References 30 publications

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

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

Symptomatic Anti-Neutrophil Cytoplasmic Antibody-Positive Disease Complicating Subacute Bacterial Endocarditis: To Treat or Not to Treat?

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