Proteinase‑3‑antineutrophil Cytoplasmic Antibody‑associated Vasculitis Secondary to Subacute Infective Endocarditis: A Case Report

Overview

Journal Exp Ther Med

Specialty Pathology

Date 2024 Apr 9

PMID 38590565

Authors

Hui Lu

Zhao Cui

Xu-Jie Zhou

Ying Yang

Xiao-Ning Han

Xi-Hui Li

Fu-de Zhou

Ming-Hui Zhao

Affiliations

Soon will be listed here.

Abstract

A 58-year-old male patient was admitted to Peking University First Hospital (Beijing, China) due to recurrent hematuria, proteinuria and kidney dysfunction. The patient was positive for proteinase-3 (PR3)-antineutrophil cytoplasmic antibody (ANCA). Pathology of the kidney showed focal proliferative necrotizing glomerulonephritis with crescent formation and immune complex-mediated glomerulonephritis. The patient was diagnosed with PR3-ANCA-associated vasculitis (AAV), received intensive immunosuppressive therapy and experienced two relapses within 1 year. After admission, aortic valve vegetation was observed via echocardiography. The patient subsequently received antibiotic treatment and valve replacement, and achieved complete remission of kidney and cardiac function. The present case emphasized the importance of identifying secondary reasons for ANCA formation, especially infective endocarditis in patients with PR3-AAV.

References

Satoskar A, Parikh S, Nadasdy T . Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. Nat Rev Nephrol. 2019; 16(1):32-50. DOI: 10.1038/s41581-019-0178-8. View

Bourgarit A, Le Toumelin P, Pagnoux C, Cohen P, Mahr A, Le Guern V . Deaths occurring during the first year after treatment onset for polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: a retrospective analysis of causes and factors predictive of mortality based on 595 patients. Medicine (Baltimore). 2005; 84(5):323-330. DOI: 10.1097/01.md.0000180793.80212.17. View

Jayne D, Merkel P, Schall T, Bekker P . Avacopan for the Treatment of ANCA-Associated Vasculitis. N Engl J Med. 2021; 384(7):599-609. DOI: 10.1056/NEJMoa2023386. View

Silva F, Pinto C, Barbosa A, Borges T, Dias C, Almeida J . New insights in cryoglobulinemic vasculitis. J Autoimmun. 2019; 105:102313. DOI: 10.1016/j.jaut.2019.102313. View

Hagen E, Daha M, Hermans J, Andrassy K, Csernok E, Gaskin G . Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. EC/BCR Project for ANCA Assay Standardization. Kidney Int. 1998; 53(3):743-53. DOI: 10.1046/j.1523-1755.1998.00807.x. View

Goodfield N, Bhandari S, Plant W, Morley-Davies A, Sutherland G . Cardiac involvement in Wegener's granulomatosis. Br Heart J. 1995; 73(2):110-5. PMC: 483773. DOI: 10.1136/hrt.73.2.110. View

Konstantinov K, Ulff-Moller C, Tzamaloukas A . Infections and antineutrophil cytoplasmic antibodies: triggering mechanisms. Autoimmun Rev. 2014; 14(3):201-3. DOI: 10.1016/j.autrev.2014.10.020. View

Fukasawa H, Hayashi M, Kinoshita N, Ishigaki S, Isobe S, Sakao Y . Rapidly progressive glomerulonephritis associated with PR3-ANCA positive subacute bacterial endocarditis. Intern Med. 2012; 51(18):2587-90. DOI: 10.2169/internalmedicine.51.8081. View

Mandell B, Calabrese L . Infections and systemic vasculitis. Curr Opin Rheumatol. 1998; 10(1):51-7. DOI: 10.1097/00002281-199801000-00008. View

10.

Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2012; 65(1):1-11. DOI: 10.1002/art.37715. View

11.

Ai S, Liu J, Ma G, Ye W, Hu R, Zhang S . Endocarditis-associated rapidly progressive glomerulonephritis mimicking vasculitis: a diagnostic and treatment challenge. Ann Med. 2022; 54(1):754-763. PMC: 8903796. DOI: 10.1080/07853890.2022.2046288. View

12.

Chen M, Jayne D, Zhao M . Complement in ANCA-associated vasculitis: mechanisms and implications for management. Nat Rev Nephrol. 2017; 13(6):359-367. DOI: 10.1038/nrneph.2017.37. View

13.

Mahr A, Batteux F, Tubiana S, Goulvestre C, Wolff M, Papo T . Brief report: prevalence of antineutrophil cytoplasmic antibodies in infective endocarditis. Arthritis Rheumatol. 2014; 66(6):1672-7. DOI: 10.1002/art.38389. View

14.

Bonaci-Nikolic B, Andrejevic S, Pavlovic M, Dimcic Z, Ivanovic B, Nikolic M . Prolonged infections associated with antineutrophil cytoplasmic antibodies specific to proteinase 3 and myeloperoxidase: diagnostic and therapeutic challenge. Clin Rheumatol. 2010; 29(8):893-904. DOI: 10.1007/s10067-010-1424-4. View

15.

Bosch X, Guilabert A, Font J . Antineutrophil cytoplasmic antibodies. Lancet. 2006; 368(9533):404-18. DOI: 10.1016/S0140-6736(06)69114-9. View

16.

Uh M, McCormick I, Kelsall J . Positive cytoplasmic antineutrophil cytoplasmic antigen with PR3 specificity glomerulonephritis in a patient with subacute bacterial endocarditis. J Rheumatol. 2011; 38(7):1527-8. DOI: 10.3899/jrheum.101322. View

17.

Xing G, Chen M, Liu G, Wang S, Zhao M . Renal neutrophils infiltration in antineutrophil cytoplasmic antibodies-negative pauci-immune crescentic glomerulonephritis. Am J Med Sci. 2010; 340(6):474-80. DOI: 10.1097/MAJ.0b013e3181f0768e. View

18.

Lacoste C, Mansencal N, Mona Ben Mrad , Goulon-Goeau C, Cohen P, Guillevin L . Valvular involvement in ANCA-associated systemic vasculitis: a case report and literature review. BMC Musculoskelet Disord. 2011; 12:50. PMC: 3050781. DOI: 10.1186/1471-2474-12-50. View

19.

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. View

20.

Yong Z, Yu X, Liu J, Zhou F, Wang S, Zhao M . Kidney Histopathologic Spectrum and Clinical Indicators Associated with MGRS. Clin J Am Soc Nephrol. 2022; 17(4):527-534. PMC: 8993475. DOI: 10.2215/CJN.12890921. View