Fukasawa Hirotaka, Hayashi Maho, Kinoshita Naoko, Ishigaki Sayaka, Isobe Shinsuke, Sakao Yukitoshi, Kato Akihiko, Fujigaki Yoshihide, Furuya Ryuichi
Renal Division, Department of Internal Medicine, Iwata City Hospital, Japan.
Intern Med. 2012;51(18):2587-90. doi: 10.2169/internalmedicine.51.8081. Epub 2012 Sep 15.
Patients with bacterial endocarditis often have renal complications. This report presents the case of an elderly man with rapidly progressive glomerulonephritis (RPGN) associated with subacute bacterial endocarditis (SBE) due to Enterococcus faecalis infection. The patient was positive for anti-proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) and rheumatoid factor (RF) with hypocomplementemia. Treatment for SBE with antibiotics and the surgical replacement of the affected valves resulted in an improvement of RPGN, the disappearance of PR3-ANCA and RF, and the normalization of hypocomplementemia. This rare case suggests the importance of recognizing the cause of positive PR3-ANCA, because SBE could be an occult cause of RPGN mimicking ANCA-associated vasculitis.
患有细菌性心内膜炎的患者常出现肾脏并发症。本报告介绍了一例老年男性病例，该患者患有与粪肠球菌感染所致亚急性细菌性心内膜炎（SBE）相关的快速进展性肾小球肾炎（RPGN）。患者抗蛋白酶3 -抗中性粒细胞胞浆抗体（PR3 - ANCA）和类风湿因子（RF）呈阳性，伴有补体血症降低。使用抗生素治疗SBE以及手术置换受累瓣膜后，RPGN有所改善，PR3 - ANCA和RF消失，补体血症降低恢复正常。这一罕见病例提示了认识PR3 - ANCA阳性原因的重要性，因为SBE可能是模仿ANCA相关血管炎的RPGN的隐匿病因。
