Fishman Troy J, Irizarry Efrain, Kaleem Ayesha, Yancey Robert, Iyer Uma G
University of Central Florida, School of Medicine, Orlando, FL.
HCA Florida North Florida Hospital, Gainesville, FL.
HCA Healthc J Med. 2022 Apr 28;3(2):63-67. doi: 10.36518/2689-0216.1389. eCollection 2022.
Description We present one of the first reported cases of prosthetic valve endocarditis, which mimicked p-antineutrophil cytoplasmic autoantibody (p-ANCA), an anti-proteinase 3 positive necrotizing glomerulonephritis caused by a cat scratch resulting in temporary dialysis. Documentation of such infections is necessary as zoonotic infections are becoming more prevalent with early identification essential for proper treatment. Although pauci-immune patterns are not a unique finding in bacterial endocarditis associated with glomerulonephritis, they are an atypical finding in endocarditis. Furthermore, p-ANCA-associated vasculitis can also be responsible for renal and cardiac disease. Because of the similar disease presentation of different etiologies (autoimmune and infectious), it can make the diagnosis much more challenging. Our patient's presentation is unique as there are no documented cases in the medical literature of resulting in temporary hemodialysis from previously healthy kidneys with recovery. Our case documents the success of early identification and appropriate treatment.
描述 我们报告了首例人工瓣膜心内膜炎病例之一，该病例类似抗蛋白酶3阳性坏死性肾小球肾炎伴抗中性粒细胞胞浆抗体（p-ANCA）阳性，由猫抓引起，导致患者需要临时透析。记录此类感染很有必要，因为人畜共患感染正变得越来越普遍，早期识别对于恰当治疗至关重要。虽然寡免疫模式并非与肾小球肾炎相关的细菌性心内膜炎的独特表现，但却是心内膜炎中的非典型表现。此外，p-ANCA相关血管炎也可导致肾脏和心脏疾病。由于不同病因（自身免疫性和感染性）的疾病表现相似，这会使诊断更具挑战性。我们患者的表现很独特，因为医学文献中没有记录过此前健康的肾脏因该病导致临时血液透析并恢复的病例。我们的病例证明了早期识别和恰当治疗的成功。
