title: Rapidly progressive glomerulonephritis associated with PR3-ANCA positive subacute bacterial endocarditis.
abstract: Patients with bacterial endocarditis often have renal complications. This report presents the case of an elderly man with rapidly progressive glomerulonephritis (RPGN) associated with subacute bacterial endocarditis (SBE) due to Enterococcus faecalis infection. The patient was positive for anti-proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) and rheumatoid factor (RF) with hypocomplementemia. Treatment for SBE with antibiotics and the surgical replacement of the affected valves resulted in an improvement of RPGN, the disappearance of PR3-ANCA and RF, and the normalization of hypocomplementemia. This rare case suggests the importance of recognizing the cause of positive PR3-ANCA, because SBE could be an occult cause of RPGN mimicking ANCA-associated vasculitis.
authors.affiliation: Renal Division, Department of Internal Medicine, Iwata City Hospital, Japan. hfukasawaucsd@gmail.com
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Fukasawa
authors.forename: Maho
authors.initials: M
authors.lastname: Hayashi
authors.forename: Naoko
authors.initials: N
authors.lastname: Kinoshita
authors.forename: Sayaka
authors.initials: S
authors.lastname: Ishigaki
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Isobe
authors.forename: Yukitoshi
authors.initials: Y
authors.lastname: Sakao
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kato
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Fujigaki
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Furuya
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000906:Antibodies / Q000097:blood*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D018450:Disease Progression; D004698:Endocarditis, Subacute Bacterial / Q000150:complications* / Q000276:immunology / Q000601:surgery; D013293:Enterococcus faecalis; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000175:diagnosis / Q000209:etiology*; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D053146:Myeloblastin / Q000276:immunology*; D012217:Rheumatoid Factor / Q000097:blood; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000906:Antibodies; D019268:Antibodies, Antineutrophil Cytoplasmic; D012217:Rheumatoid Factor; D053146:Myeloblastin