Teoh Laurence S G, Hart Hamish H, Soh May Ching, Christiansen Jonathan P, Bhally Hasan, Philips Martin S, Rai-Chaudhuri Dominic S
Department of Rheumatology, North Shore Hospital, North Shore City, New Zealand.
BMJ Case Rep. 2010 Oct 21;2010:bcr0420102945. doi: 10.1136/bcr.04.2010.2945.
A 28-year-old man with a bicuspid aortic valve presented with facial droop and slurred speech with several months of constitutional symptoms of night sweats, weight loss and productive cough. Examination confirmed aortic regurgitation, palpable spleen and left facial droop. Multiple peripheral blood cultures were negative. Inflammatory markers, cytoplasmic staining antineutrophil cytoplasmic antibodies (cANCA) and anti-PR3 antibody were all elevated. MRI of the brain and CT of the chest and abdomen confirmed embolic infarcts to brain, kidney and spleen. Transoesophageal echocardiogram (ECG) showed valve vegetations and severe aortic regurgitation. Endocardial Wegener's granulomatosis was considered. Aortic valve replacement was performed. Grindings from aortic valve leaflets were analysed for rpoB gene, which confirmed the presence of Bartonella henselae. Serological assays demonstrated B henselae IgM 20 (normal <20) and IgG >2048 (normal < 64). The patient completely recovered after prolonged antibiotic treatment. Culture-negative infective endocarditis may mimic vasculitis and be associated with positive cANCA. Serology and molecular techniques may aid diagnosis.
一名患有二叶式主动脉瓣的28岁男性，出现面部下垂和言语不清，并伴有数月盗汗、体重减轻和咳痰等全身症状。检查证实有主动脉反流、可触及的脾脏和左侧面部下垂。多次外周血培养均为阴性。炎症标志物、胞浆型抗中性粒细胞胞浆抗体（cANCA）和抗PR3抗体均升高。脑部MRI以及胸部和腹部CT证实脑、肾和脾有栓塞性梗死。经食管超声心动图（ECG）显示瓣膜赘生物和严重的主动脉反流。考虑为心内膜韦格纳肉芽肿。进行了主动脉瓣置换术。对主动脉瓣叶的研磨物进行rpoB基因分析，证实存在汉赛巴尔通体。血清学检测显示汉赛巴尔通体IgM为20（正常<20），IgG>2048（正常<64）。经过长期抗生素治疗后，患者完全康复。培养阴性的感染性心内膜炎可能模仿血管炎，并与cANCA阳性有关。血清学和分子技术可能有助于诊断。
