Kawamorita Yosuke, Fujigaki Yoshihide, Imase Atsuko, Arai Shigeyuki, Tamura Yoshifuru, Tanemoto Masayuki, Uozaki Hiroshi, Yamaguchi Yutaka, Uchida Shunya
Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Case Rep Nephrol. 2014;2014:569047. doi: 10.1155/2014/569047. Epub 2014 Nov 23.
We report a 42-year-old man with subacute infectious endocarditis (IE) with septic pulmonary embolism, presenting rapidly progressive glomerulonephritis and positive proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA). He had no previous history of heart disease. Renal histology revealed diffuse endocapillary proliferative glomerulonephritis with complement 3- (C3-) dominant staining and subendothelial electron dense deposit, mimicking C3 glomerulonephritis. Successful treatment of IE with valve plastic surgery gradually ameliorated hypocomplementemia and renal failure; thus C3 glomerulonephritis-like lesion in this case was classified as postinfectious glomerulonephritis. IE associated glomerulonephritis is relatively rare, especially in cases with no previous history of valvular disease of the heart like our case. This case also reemphasizes the broad differential diagnosis of renal involvement in IE.
我们报告了一名42岁男性，患有亚急性感染性心内膜炎（IE）并伴有脓毒性肺栓塞，表现为快速进展性肾小球肾炎且蛋白酶3-抗中性粒细胞胞浆抗体（PR3-ANCA）呈阳性。他既往无心脏病史。肾脏组织学检查显示弥漫性毛细血管内增生性肾小球肾炎，以补体3（C3）为主的染色以及内皮下电子致密沉积物，类似于C3肾小球肾炎。通过瓣膜整形手术成功治疗IE后，低补体血症和肾衰竭逐渐改善；因此，该病例中类似C3肾小球肾炎的病变被归类为感染后肾小球肾炎。IE相关的肾小球肾炎相对少见，尤其是像我们病例这样既往无心脏瓣膜病病史的情况。该病例还再次强调了IE肾受累的广泛鉴别诊断。
