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Infective endocarditis mimics ANCA associated glomerulonephritis
Mohammad Reza Ardalan1, Matias Trillini
1Department of Nephrology, Tabriz University of Medical Sciences, Tabriz, Iran.
Caspian Journal of Internal Medicine
|September 7, 2013
Summary
Sub-acute bacterial endocarditis (SBE) can mimic ANCA-associated glomerulonephritis, leading to misdiagnosis. Prompt diagnosis and appropriate treatment are crucial to prevent severe complications from this rare presentation.
Area of Science:
- Nephrology
- Cardiology
- Infectious Diseases
Background:
- Sub-acute bacterial endocarditis (SBE) can present atypically with small vessel vasculitis features.
- Patients with SBE may exhibit serological abnormalities, including anti-neutrophil cytoplasmic antibodies (ANCA).
Observation:
- A 57-year-old male presented with rapidly progressive renal failure and positive PR3-ANCA serology.
- Renal biopsy showed focal and segmental glomerular necrosis, initially suggesting ANCA-associated glomerulonephritis.
- Corticosteroid therapy worsened the patient's condition, prompting further investigation.
Findings:
- Cardiac ultrasound revealed large vegetations on the aortic valve, confirming infective endocarditis.
- The patient's condition improved significantly after antibiotic therapy and aortic valve surgery.
- Serum creatinine normalized to 1.7 mg/dL post-treatment.
Implications:
- Misdiagnosing SBE as ANCA-associated vasculitis can lead to inappropriate immunosuppressive therapy.
- Delayed or incorrect treatment for SBE can have severe, potentially fatal, consequences.
- This case highlights the importance of considering infective endocarditis in patients presenting with ANCA-associated glomerulonephritis features.
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