• Ayumi Yoshifuji, Yuuka Hibino, Motoaki Komatsu, Seiichi Yasuda, Koji Hosoya, Emi Kobayashi, Yuko Baba, Shigemichi Hirose, Akinori Hashiguchi, Yoshihiko Kanno, and Munekazu Ryuzaki.
• Division of Nephrology, Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Japan.
• Intern. Med. 2021 Jun 15; 60 (12): 1899-1906.

AbstractA 65-year-old man with valvular disorder presented to his physician because of widespread purpura in both lower extremities. Blood tests showed elevated serum creatinine levels and proteinase 3-anti-neutrophil cytoplasmic antibody (ANCA) with hematuria, suggesting ANCA-related rapidly progressive glomerulonephritis (RPGN). Although multiple blood cultures were negative, transthoracic echocardiography revealed warts in the valves, and a renal biopsy also showed findings of glomerular infiltration by mononuclear leukocytes and C3 deposition in the glomeruli, suggesting infection-related glomerulonephritis. Later, Bartonella antibody turned positive. Antimicrobial treatment improved the purpura and renal function without any recurrence. ANCA-positive RPGN requires the exclusion of infective endocarditis, especially that induced by Bartonella spp.

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