Journal
CASE REPORTS IN NEPHROLOGY AND DIALYSIS
Volume 2, Issue 1, Pages 25-32Publisher
KARGER
DOI: 10.1159/000339409
Keywords
Infective endocarditis; Pauci-immune glomerulonephritis; Interstitial nephritis; Vasculitis; Renal failure; Anti-neutrophil cytoplasmic antibodies; ANCA
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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.
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