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Characteristics and Diagnostic Challenge of Antineutrophil Cytoplasmic Antibody Positive Infective Endocarditis

SanXi Ai1, XinPei Liu2, Gang Chen1

  • 1Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

The American Journal of Medicine
|July 12, 2022
PubMed

Insights

Antineutrophil cytoplasmic antibody (ANCA) is found in infective endocarditis, linked to longer disease duration and kidney issues. ANCA-positive infective endocarditis can mimic ANCA-associated vasculitis, posing diagnostic challenges.

Area of Science:

  • Nephrology
  • Rheumatology
  • Infectious Diseases

Background:

  • Antineutrophil cytoplasmic antibody (ANCA) presence in infective endocarditis (IE) is documented but its clinical implications remain unclear.
  • Investigating the association between ANCA and IE characteristics is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To investigate the clinical implications of ANCA in patients diagnosed with infective endocarditis.
  • To highlight the diagnostic challenges posed by ANCA-positive infective endocarditis.

Main Methods:

  • A retrospective study included 237 patients with infective endocarditis and available ANCA results.
  • Clinical and pathological characteristics were compared between ANCA-positive and ANCA-negative groups.

Main Results:

  • 18.1% of patients were ANCA-positive, predominantly c-ANCA/anti-PR3.
  • ANCA-positive IE patients exhibited longer disease duration, more purpura, macrohematuria, proteinuria, acute kidney injury, and rapidly progressive glomerulonephritis.
  • Two ANCA-positive IE patients showed pauci-immune necrotizing and crescentic glomerulonephritis on histology.

Conclusions:

  • ANCA is present in a significant proportion of IE patients, associated with specific clinical and renal manifestations.
  • ANCA-positive IE can be misdiagnosed as ANCA-associated vasculitis, underscoring diagnostic difficulties.
  • Further research is needed to determine if ANCA is pathogenic in IE-associated small vessel vasculitis.
Abstract

Keywords:
ANCADiagnosisGlomerulonephritisInfective endocarditis

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