Successful recovery of infective endocarditis-induced rapidly progressive glomerulonephritis by steroid therapy combined with antibiotics: a case report.
BACKGROUND
The mortality rate among patients with infective endocarditis, especially associated with the presence of complications or coexisting conditions such as renal failure and the use of combined medical and surgical therapy remains still high. Prolonged parenteral administration of a bactericidal antimicrobial agent or combination of agents is usually recommended, however, the optimal therapy for infective endocarditis associated with renal injury is not adequately defined.


METHODS
Patient was a 24-years old man who presented to our hospital with fever, fatigue, and rapidly progressive glomerulonephritis. He had a history of ventricular septum defect (VSD). A renal biopsy specimen revealed crescentic glomerulonephritis and echocardiogram revealed VSD with vegetation on the tricuspid valve. Specimens of blood demonstrated Propionibacterium Acnes. The intensive antibiotic therapy with penicillin G was started without clinical improvement of renal function or resolution of fever over the next 7 days. After the short-term treatment of low dose of corticosteroid combined with continuous antibiotics, high fever and renal insufficiency were dramatically improved.


CONCLUSIONS
Although renal function in our case worsened despite therapy with antibiotics, a short-term and low dose of corticosteroid therapy with antibiotics was able to recover renal function and the patient finally underwent tricuspid valve-plasty and VSD closure. We suggest that the patients with rapidly progressive glomerulonephritis associated with infective endocarditis might be treated with a short-term and low dose of corticosteroid successfully.
Koya
Daisuke
D
Department of Medicine, Shiga University of Medical Science, Seta, Otsu, Shiga 520-2192, Japan. koya@belle.shiga-med.ac.jp
Shibuya
Kazuyuki
K
Kikkawa
Ryuichi
R
Haneda
Masakazu
M
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005921:Glomerulonephritis / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008297:Male; D010400:Penicillin G / Q000627:therapeutic use*; D011425:Propionibacterium acnes; D020127:Recovery of Function; D014261:Tricuspid Valve / Q000000981:diagnostic imaging
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D010400:Penicillin G