Streptococcus sanguinis Endocarditis Mimicking ANCA-Associated Vasculitis

Bacterial endocarditis presents as inflammation of the endocardium and valves of the 4 layers of the heart. The presentation and sequelae of bacterial endocarditis may vary and in certain circumstances may mimic rheumatologic disease. Antinuclear cytoplasmic antibody (ANCA)-positive bacterial endocarditis constitutes a special subgroup of bacterial endocarditis. Based on a systematic review, ANCA positivity was detected in 18% to 43% of infectious endocarditis cases, with 79% cytoplasmic ANCA/proteinase 3, 11% ANCA/myeloperoxidase positive, and 8% double positive.¹ This paper presents a case of a middle-aged man recently started on hemodialysis who presented to the hospital for evaluation of a new rash. He was later diagnosed with Streptococcus sanguinis infective endocarditis of the aortic valve. He had positive cytoplasmic ANCA and biopsy evidence of leukocytoclastic vasculitis.