Abstract
We report a case of subacute bacterial endocarditis associated with small vessel vasculitis and a strongly positive cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) test. It is important to recognize this cause of positive c-ANCA because infectious endocarditis may closely mimic the clinical manifestations of ANCA-associated vasculitides such as Wegener granulomatosis or microscopic polyangiitis. Furthermore, ANCA-associated vasculitis may result in noninfectious endocarditis, which may be confused with bacterial endocarditis. In this paper, we review reported cases of ANCA-positive bacterial endocarditis and compare them to the reported cases of ANCA-associated idiopathic vasculitis with endocardial compromise.
Abbreviations
- ANCA:
-
Antineutrophil cytoplasmic antibodies
- c-ANCA:
-
Cytoplasmic antineutrophil cytoplasmic antibodies
- p-ANCA:
-
Perinuclear antineutrophil cytoplasmic antibodies
- SBE:
-
Subacute bacterial endocarditis
- SVV:
-
Small vessel vasculitis
References
Jennette JC, Falk RJ (1997) Small-vessel vasculitis. N Engl J Med 337(21):1512–1523
Harper L, Savage CO (2000) Pathogenesis of ANCA-associated systemic vasculitis. J Pathol 190(3):349–359
Harris A, Chang G, Vadas M et al (1999) ELISA is the superior method for detecting antineutrophil cytoplasmic antibodies in the diagnosis of systemic necrotising vasculitis. J Clin Pathol 52(9):670–676
Lane SK, Gravel JW Jr (2002) Clinical utility of common serum rheumatologic tests. Am Fam Physician 65(6):1073–1080
Fries JF, Hunder GG, Bloch DA et al (1990) The American College of Rheumatology 1990 criteria for the classification of vasculitis. Summary. Arthritis Rheum 33(8):1135–1136
Subra JF, Michelet C, Laporte J et al (1998) The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) in the course of subacute bacterial endocarditis with glomerular involvement, coincidence or association. Clin Nephrol 49(1):15–18
Haseyama T, Imai H, Komatsuda A et al (1998) Proteinase-3-antineutrophil cytoplasmic antibody (PR3-ANCA) positive crescentic glomerulonephritis in a patient with Down’s syndrome and infectious endocarditis. Nephrol Dial Transplant 13(8):2142–2146
Choi HK, Lamprecht P, Niles JL et al (2000) Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies. Arthritis Rheum 43(1):226–231
Wagner J, Andrassy K, Ritz E (1991) Is vasculitis in subacute bacterial endocarditis associated with ANCA? Lancet 337(8744):799–800
Soto A, Jorgensen C, Oksman F et al (1994) Endocarditis associated with ANCA. Clin Exp Rheumatol 12(2):203–204
de Corla-Souza A, Cunha BA (2003) Streptococcal viridans subacute bacterial endocarditis associated with antineutrophil cytoplasmic autoantibodies (ANCA). Heart Lung 32(2):140–143
Messiaen T, Lefebvre C, Zech F et al (1997) ANCA-positive rapidly progressive glomerulonephritis: there may be more to the diagnosis than you think! Nephrol Dial Transplant 12(4):839–841
Anthony DD, Askari AD, Wolpaw T et al (1999) Wegener granulomatosis simulating bacterial endocarditis. Arch Intern Med 159(15):1807–1810
Dabbagh S, Chevalier RL, Sturgill BC (1982) Prolonged anuria and aortic insufficiency in a child with Wegener’s granulomatosis. Clin Nephrol 17(3):155–159
Greidinger EL, Lemes V, Hellmann DB (1996) Cardiac valve disease in Wegener’s granulomatosis. J Rheumatol 23(8):1485–1487
Ramakrishnan S, Narang R, Khilnani GC et al (2004) Wegener’s granulomatosis mimicking prosthetic valve endocarditis. Cardiology 102(1):35–36
Levine H, Madden TJ (1957) Wegener’s granulomatosis; report of a case. Am Heart J 53(4):632–637
Paik ML, MacLennan GT, Seftel AD (1999) Embolic testicular infarction secondary to nonbacterial thrombotic endocarditis in Wegener’s granulomatosis. J Urol 161(3):919–920
Bruno P, Le Hello C, Massetti M et al (2000) Necrotizing granulomata of the aortic valve in Wegener’s disease. J Heart Valve Dis 9(5):633–635
Mishell JM (2002) Cases from the Osler Medical Service at Johns Hopkins University: cardiac valvular lesions in Wegener’s granulamatosis. Am J Med 113(7):607–609
Yanda RJ, Guis MS, Rabkin JM (1989) Aortic valvulitis in a patient with Wegener’s granulomatosis. West J Med 151(5):555–556
Gerbracht DD, Savage RW, Scharff N (1987) Reversible valvulitis in Wegener’s granulomatosis. Chest 92(1):182–183
Stollberger C, Finsterer J, Zlabinger GJ et al (2003) Antineutrophil cytoplasmic autoantibody–negative antiproteinase 3 syndrome presenting as vasculitis, endocarditis, polyneuropathy and Dupuytren’s contracture. J Heart Valve Dis 12(4):530–534
Davenport A, Goodfellow J, Goel S et al (1994) Aortic valve disease in patients with Wegener’s granulomatosis. Am J Kidney Dis 24(2):205–208
Fox AD, Robbins SE (1994) Aortic valvulitis complicating Wegener’s granulomatosis. Thorax 49(11):1176–1177
Leff RD, Hellman RN, Mullany CJ (1999) Acute aortic insufficiency associated with Wegener granulomatosis. Mayo Clin Proc 74(9):897–899
Goodfield NE, Bhandari S, Plant WD et al (1995) Cardiac involvement in Wegener’s granulomatosis. Br Heart J 73(2):110–115
Grant SC, Levy RD, Venning MC et al (1994) Wegener’s granulomatosis and the heart. Br Heart J 71(1):82–86
Hafezi-Rachti S, Riess R, Weidner S et al (2000) The patient with Wegener’s granulomatosis and an intrasplenic mass of unknown origin. Nephrol Dial Transplant 15(6):906–908
Rentsch J, McColl G (2000) Splenic infarction in Wegener’s granulomatosis. J Rheumatol 27(6):1554–1555
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Julio A. Chirinos and Vicente F. Corrales-Medina contributed equally in the preparation of this manuscrip
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Chirinos, J.A., Corrales-Medina, V.F., Garcia, S. et al. Endocarditis associated with antineutrophil cytoplasmic antibodies: a case report and review of the literature. Clin Rheumatol 26, 590–595 (2007). https://doi.org/10.1007/s10067-005-0176-z
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DOI: https://doi.org/10.1007/s10067-005-0176-z