title: Antineutrophil cytoplasmic autoantibody-negative antiproteinase 3 syndrome presenting as vasculitis, endocarditis, polyneuropathy and Dupuytren's contracture.
abstract: Antiproteinase 3 antibodies (antiPR3) are assumed to be subtypes of antineutrophil cytoplasmic autoantibodies (ANCA), with a high specificity for active Wegener's granulomatosis and microscopic polyangiitis. Thus, antiPR3 positivity in ELISA, together with negativity in indirect immunofluorescence (IIF) is a rare finding. A 56-year-old man with Dupuytren's contracture and polyneuropathy was admitted for leukocytoclastic vasculitis. Echocardiography, performed because of fever and dyspnea, detected aortic valve endocarditis. Because of severe aortic insufficiency the valve was replaced. Blood cultures and bacteriologic investigations of the explanted valve were negative. AntiPR3 were elevated (123-163 U/ml; normal <6 U/ml), together with negativity in IIF. This case shows that antiPR3 elevation with negative ANCA may be associated with vasculitis, endocarditis, polyneuropathy and Dupuytren's contracture. A causal relationship between the clinical presentation and antiPR3 elevation is likely. In order not to miss such cases of vasculitis, combined screening by IIF and ELISA is recommended in selected cases.
authors.affiliation: 2nd Medical Department, Krankenanstalt Rudolfstiftung, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Stöllberger
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Zlabinger
authors.forename: Felix
authors.initials: F
authors.lastname: Weihsengruber
authors.forename: Susanne
authors.initials: S
authors.lastname: Redtenbacher
authors.forename: Gerhard
authors.initials: G
authors.lastname: Bonner
authors.forename: Kurt
authors.initials: K
authors.lastname: Herkner
authors.forename: Manfred
authors.initials: M
authors.lastname: Deutsch
mesh_terms: D019268:Antibodies, Antineutrophil Cytoplasmic; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D003937:Diagnosis, Differential; D004387:Dupuytren Contracture / Q000175:diagnosis* / Q000382:microbiology; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D019084:Fluorescent Antibody Technique, Indirect; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000175:diagnosis* / Q000382:microbiology; D013577:Syndrome; D014210:Treponema pallidum; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000175:diagnosis* / Q000382:microbiology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic