title: Dual ANCA positivity in subacute bacterial endocarditis.
abstract: Nine cases of subacute bacterial endocarditis (SBE) associated with anti-PR3 ANCA have been described in the literature to date. We describe 2 cases of SBE associated with dual ANCA positivity (anti-PR3 and anti-MPO ANCA.) To our knowledge, these are the first such reported cases. One case was associated with cutaneous vasculitis, and the second with predisposing factors for SBE. ANCA titers resolved or decreased in both during initial corticosteroid therapy for suspected vasculitis. Follow-up of these patients revealed no evidence of the common ANCA associations such as Wegener granulomatosis. Rheumatologists, if aware of ANCA association with SBE, can avoid inappropriate immunosuppressive treatments.
authors.affiliation: Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Tiliakos
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Tiliakos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000187:drug effects / Q000276:immunology*; D017548:Echocardiography, Transesophageal; D004698:Endocarditis, Subacute Bacterial / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013290:Streptococcal Infections / Q000150:complications* / Q000188:drug therapy; D014657:Vasculitis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D034363:Viridans Streptococci / Q000187:drug effects / Q000472:pathogenicity*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D019268:Antibodies, Antineutrophil Cytoplasmic