Proteinase-3-antineutrophil cytoplasmic antibody (PR3-ANCA) positive crescentic glomerulonephritis in a patient with Down's syndrome and infectious endocarditis

Haseyama, Toshiyuki; Imai, Hirokazu; Komatsuda, Atsushi; Hamai, Keiko; Oda, Hiroshi; Kibira, Satoshi; Miura, Akira B.

doi:10.1093/ndt/13.8.2142

Cited by 49 publications

(51 citation statements)

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“…These previously reported cases were reinterpreted using an ANCA scoring system that combines immunofluorescence and antigen-specific ANCA test results. Table 1 summarizes the reported cases of infectious diseases associated with positive ANCA tests confirmed by antigen-specific tests (3,(7)(8)(9)(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

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Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies

Choi

Lamprecht

Niles

et al. 2000

Arthritis & Rheumatism

155

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Objective. To report a potentially important limitation of antineutrophil cytoplasmic antibody (ANCA) testing: positive results in patients with subacute bacterial endocarditis (SBE).Methods. We describe 3 patients with SBE who presented with features mimicking ANCA-associated vasculitis (AAV) and positive findings on tests for cytoplasmic ANCA (cANCA) by indirect immunofluorescence and for anti-proteinase 3 (anti-PR3) antibodies by antigen-specific enzyme-linked immunosorbent assay (ELISA). We also reviewed the published literature describing infectious diseases with (misinterpreted) positive ANCA results through a Medline search of English-language articles published between 1966 and January 1999. These previously reported cases were reinterpreted using an ANCA scoring system that combines the findings of immunofluorescence and antigenspecific ELISA testing.Results. We are now aware of a total of 7 cases of SBE with positive cANCA and anti-PR3 antibodies. We are not aware of any cases of SBE associated with antimyeloperoxidase/perinuclear ANCA. Clinical manifestations mimicking AAV included glomerulonephritis, purpura, epistaxis, or sinus symptoms in 6 of the patients. Streptococcal species were identified in 5 patients, and cardiac valvular abnormalities were demonstrated in 6. All patients except 1, who died of a complication of SBE, recovered with antibiotic therapy.Conclusion. Findings of tests for anti-PR3/ cANCA antibodies may be positive in patients with SBE.

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Section: Discussionmentioning

confidence: 99%

“…There have been multiple reports describing the presence of ANCA in occasional patients with a variety of infectious diseases (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The majority of these reports do not document the presence of antibodies to PR3 or MPO by antigen-specific immunoassays (2,4,6).…”

mentioning

confidence: 99%

Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies

Choi

Lamprecht

Niles

et al. 2000

Arthritis & Rheumatism

155

View full text Add to dashboard Cite

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“…Laboratory data demonstrated a white blood cell count of 3,870/μL, a red blood cell count of 457×10 6 /μL, hemoglobin of 13.9 g/dL, hematocrit of 42%, platelet count of 22.5×10 4 /μL, total serum protein of 9.3 g/dL, albumin of 3.9 g/dL, blood urea nitrogen (BUN) of 13.0 mg/dL, serum creatinine (Cr) of 1.51 mg/dL, estimated GFR of 39.1 mL/ min/m 2 body surface area, and no urinary protein. Aspartate aminotransferase and alanine aminotransferase levels were 21 and 13 U/L, respectively.…”

Section: Case Reportmentioning

confidence: 99%

“…On the other hand, proteinase 3 anti-neutrophil cytoplasmic antibody (PR 3-ANCA) is a well known disease marker autoantibody found in Wegener's granulomatosis (5). However, several other diseases are reported to be associated with PR3-ANCA (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Proteinase 3 Anti-Neutrophil Cytoplasmic Antibody (PR3-ANCA) Positive IgG4-Related Retroperitoneal Fibrosis: Utility of PET-CT with <sup>18</sup>F-Fluorodeoxy Glucose (FDG)

et al. 2012

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A 55-year-old man showed a serum creatinine level of 1.51 mg/dL, CRP of 0.79 mg/dL, and proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA) of 43.9 EU (normal range: below 10). The serum levels and ratios of IgG1, IgG2, IgG3, and IgG4 to total IgG were 1,570 mg/dL (49%), 1,190 mg/dL (37%), 82 mg/dL (3%), and 351 mg/dL (11%), respectively. Positron emission tomography and CT with 18 Ffluorodeoxyglucose (PET-CT) demonstrated retroperitoneal fibrosis. After a diagnosis of IgG4-related retroperitoneal fibrosis with PR3-ANCA was made, oral prednisolone improved serum creatinine and the titer of PR3-ANCA to normal levels, with no abnormal findings on PET-CT.

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“…Haseyama, et al suggested that patients with high PR3 titers in association with SBE be initially treated with immunosuppression 13 . There have been 6 cases of c-ANCA/PR3-associated SBE treated initially with immunosuppression or simultaneously with antibiotics because of delayed or equivocal diagnosis 2,3,5,6,10 .…”

Section: To the Editormentioning

confidence: 99%

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

Uh¹,

McCormick²,

Kelsall³

2011

J Rheumatol

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Proteinase-3-antineutrophil cytoplasmic antibody (PR3-ANCA) positive crescentic glomerulonephritis in a patient with Down's syndrome and infectious endocarditis

Cited by 49 publications

References 0 publications

Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies

Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies

Proteinase 3 Anti-Neutrophil Cytoplasmic Antibody (PR3-ANCA) Positive IgG4-Related Retroperitoneal Fibrosis: Utility of PET-CT with <sup>18</sup>F-Fluorodeoxy Glucose (FDG)

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

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