Vol.21 No.5

Case Report

Three cases of PR3-ANCA positive subacute endocarditis caused by attenuated bacteria (Propionibacterium, Gemella, and Bartonella) complicated with kidney injury

Authors

Kenji Satake1 , Isao Ohsawa1 , Noriyoshi Kobayashi1 , Ken Osaki1 , Hitoe Toyoda1 , Satoshi Horikoshi1 , Yasuhiko Tomino1

  • Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
Received:

6 October 2010

Accepted:

7 February 2011

Published online:

15 March 2011

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Abstract

Subacute bacterial endocarditis (SBE) associated with antiproteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) has previously been reported in 10 cases of Streptococcus viridans and in 1 case of Escherichia faecalis infection. Most of these patients had hypocomplementemia and were positive for several autoantibodies. The infections in most of these patients showed good responses to antibiotic treatment. We report three patients with ANCA-positive SBE, which was induced by attenuated slow-growing intracellular pathogens; these patients had severe complications, such as acute kidney injury, cerebral embolism, and aortic valve destruction.

Key words

PR3-ANCA - Infectious endocarditis - Acute kidney injury - Attenuated bacteria - Hypocomplementemia