Enterococcal endocarditis associated with crescentic glomerulonephritis.
Glomerulonephritis secondary to infective endocarditis (IE) is an uncommon diagnosis and is usually associated with cardiac valvular infection by blood-culture-positive bacteria. We report a case of necrotizing glomerulonephritis associated with culture-positive endocarditis caused by Enterococcus faecalis. The patient presented with renal abnormalities and was further investigated by renal biopsy. He had immune complex-mediated necrotizing and crescentic glomerulonephritis with mesengial and capillary deposition of immunoglobulin M (Ig M), Ig G, and complement 3 (C3). He was treated with antibiotics, including ampicillin and gentamicin. In addition, steroid and cyclophosphamide were administered. The patient died of renal failure 48 days after hospital admission. In conclusion, glomerulonephritis caused by Enterococcus faecalis endocarditis is an immune-complex-mediated disease characterized by necrotizing and crescentic glomerular lesions that can be fatal despite aggressive antimicrobial and immunosuppressive therapy.
Kirkpantur
Alper
A
Department of Internal Medicine, Nephrology Unit, Hacettepe University, School of Medicine, Eriskin Nefroloji Bolumu 06100, Sihhiye, Ankara, Turkey. alperk@hacettepe.edu.tr.
Altinbas
Akif
A
Department of Internal Medicine, Hacettepe University, School of Medicine, Ankara, Turkey.
Arici
Mustafa
M
Department of Internal Medicine, Nephrology Unit, Hacettepe University, School of Medicine, Eriskin Nefroloji Bolumu 06100, Sihhiye, Ankara, Turkey.
Baydar
Dilek Ertoy
DE
Department of Pathology, Hacettepe University, School of Medicine, Ankara, Turkey.
Altun
Bulent
B
Department of Internal Medicine, Nephrology Unit, Hacettepe University, School of Medicine, Eriskin Nefroloji Bolumu 06100, Sihhiye, Ankara, Turkey.
Arslan
Serap
S
Department of Internal Medicine, Gastroenterology Unit, Hacettepe University, School of Medicine, Ankara, Turkey.
D000890:Anti-Infective Agents / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D017809:Fatal Outcome; D005921:Glomerulonephritis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007673:Kidney Cortex Necrosis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents