Konstantinov Konstantin N, Harris Alexis A, Hartshorne Michael F, Tzamaloukas Antonios H
Rheumatology Section, Raymond G. Murphy VA Medical Center, University of New Mexico School of Medicine, Albuquerque, N. Mex., USA ; Department of Medicine, University of New Mexico School of Medicine, Albuquerque, N. Mex., University of New Mexico School of Medicine, Albuquerque, N. Mex., USA.
Case Rep Nephrol Urol. 2012 Jan;2(1):25-32. doi: 10.1159/000339409. Epub 2012 May 24.
A 54-year-old man was diagnosed with Streptococcus mutans endocarditis of the mitral valve. Serological tests disclosed the presence of multiple autoantibodies including c-ANCA, anti-PR3 and anti-MPO. While the fever subsided with antibiotics, mental status and renal function deteriorated rapidly. Kidney biopsy revealed pauci-immune glomerulonephritis and acute eosinophilic interstitial nephritis. The abnormal clinical features improved rapidly after addition of corticosteroids and cyclophosphamide to the antibiotics. Immunosuppressive agents may be required in a fraction of the patients with infective endocarditis who develop ANCA and ANCA-mediated renal disease. Histological identification of the type of renal disease is imperative for the choice of the treatment.
一名54岁男性被诊断为二尖瓣变形链球菌性心内膜炎。血清学检查发现存在多种自身抗体，包括c-ANCA、抗PR3和抗MPO。虽然使用抗生素后发热消退，但精神状态和肾功能迅速恶化。肾活检显示寡免疫性肾小球肾炎和急性嗜酸性间质性肾炎。在抗生素治疗基础上加用皮质类固醇和环磷酰胺后，异常临床特征迅速改善。部分发生ANCA及ANCA介导的肾脏疾病的感染性心内膜炎患者可能需要使用免疫抑制剂。肾脏疾病类型的组织学鉴定对于治疗方案的选择至关重要。
