title: Symptomatic anti-neutrophil cytoplasmic antibody-positive disease complicating subacute bacterial endocarditis: to treat or not to treat?
abstract: A 54-year-old man was diagnosed with Streptococcus mutans endocarditis of the mitral valve. Serological tests disclosed the presence of multiple autoantibodies including c-ANCA, anti-PR3 and anti-MPO. While the fever subsided with antibiotics, mental status and renal function deteriorated rapidly. Kidney biopsy revealed pauci-immune glomerulonephritis and acute eosinophilic interstitial nephritis. The abnormal clinical features improved rapidly after addition of corticosteroids and cyclophosphamide to the antibiotics. Immunosuppressive agents may be required in a fraction of the patients with infective endocarditis who develop ANCA and ANCA-mediated renal disease. Histological identification of the type of renal disease is imperative for the choice of the treatment.
authors.affiliation: Rheumatology Section, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, N. Mex., USA ; Department of Medicine, University of New Mexico School of Medicine, Albuquerque, N. Mex., University of New Mexico School of Medicine, Albuquerque, N. Mex., USA.
authors.forename: Konstantin N
authors.initials: KN
authors.lastname: Konstantinov
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Harris
authors.forename: Michael F
authors.initials: MF
authors.lastname: Hartshorne
authors.forename: Antonios H
authors.initials: AH
authors.lastname: Tzamaloukas