• Medicine · Aug 2021

    Case Reports

    A case report of PR-3-ANCA-positive glomerulonephritis with histological features of GPA associated with infectious endocarditis.

    • Momoko Hirata, Haruhisa Miyazawa, Junki Morino, Shohei Kaneko, Saori Minato, Yanai Katsunori, Hiroki Ishii, Taisuke Kitano, Kiyonori Ito, Keiji Hirai, Takashi Oda, Akira Shimizu, Yoshihiko Ueda, and Yoshiyuki Morishita.
    • Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
    • Medicine (Baltimore). 2021 Aug 13; 100 (32): e26905e26905.

    RationaleSeveral renal diseases are associated with infectious endocarditis. However, there are few reports on patients with granulomatosis with polyangiitis (GPA) associated with infectious endocarditis, and there is no consensus for appropriate treatment.Patients ConcernsA 35 -years-old man with congenital ventricular septal defect presented severe anemia, hematuria and proteinuria. The blood and urine examinations showed elevated white blood cells (12,900 cells/μL), C-reactive protein level (13.1 mg/dL) and proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level (11.0 IU/mL), severe anemia (hemoglobin: 6.1 g/dL) and renal dysfunction [estimated glomerular filtration rate (eGFR): 12.7 ml/min.1.78 m2 with hematuria and proteinuria].DiagnosesThe patient was diagnosed with crescentic glomerulonephritis with histological features of GPA associated with infectious endocarditis by renal biopsy and transthoracic echocardiography.InterventionsAntibacterial drugs (ampicillin-sulbactam) were administrated. No immunomodulating agents were used because immunosuppressive drugs may worsen infectious endocarditis. Subsequently, renal function and urinary findings improved. However, infectious endocarditis was not improved. Therefore, valve replacements and ventricular septal closure surgery were conducted.OutcomesThereafter, his postoperative course was uneventful, renal function improved (eGFR: 64.3 ml/min.1.78 m2), and PR3-ANCA level normalized.LessonsWe reported a case report of PR3-ANCA positive glomerulonephritis with histological features of GPA associated with infectious endocarditis. Physicians might note this renal complication when they manage infectious endocarditis.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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