Infective endocarditis with antineutrophil cytoplasmic antibody: report of 13 cases and literature review.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*diagnosis ; Antibodies, Antineutrophil Cytoplasmic/*immunology ; Endocarditis/*epidemiology ; Endocarditis/*pathology; Adult ; Antibodies, Antineutrophil Cytoplasmic/blood ; China/epidemiology ; Diagnosis, Differential ; Endocarditis/diagnosis ; Endocarditis/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prevalence

Objective: Chronic infections tend to induce the production of antineutrophil cytoplasmic antibody (ANCA). Infective endocarditis (IE) has been reported to exhibit positive ANCA tests and to mimic ANCA-associated vasculitis, which may lead to a misdiagnosis and inappropriate treatment. The aim of this study was to clarify whether there is any difference in the clinical features between ANCA-positive IE and ANCA-negative IE.
Methods: A retrospective study was carried out on 39 IE patients whose proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA levels were measured. After dividing the patients into ANCA-positive and ANCA-negative IE, we compared their clinical features.
Results: we compared 13 ANCA-positive IE patients with 26 ANCA-negative IE patients. All 13 ANCA-positive IE patients were proteinase-3-ANCA positive. Compared with the ANCA-negative IE group, the prevalence of edema of the lower extremities, the serum lactate dehydrogenase (LDH) level and positive blood cultures rate were higher in ANCA-positive IE group, but there was no significant difference in other clinical features.
Conclusion: Therefore, if a patient presents with fever, arthralgia, skin rash and is ANCA-positive, appropriate steps should be taken to exclude infection (especially IE) before confirming the diagnosis of ANCA-associated vasculitis and embarking on long-term immunosuppressive therapy.

Clin Nephrol. 1998 Jan;49(1):15-8. (PMID: 9491280)
Case Rep Nephrol Urol. 2012 Jan;2(1):25-32. (PMID: 23197952)
BMC Nephrol. 2012 Dec 26;13:174. (PMID: 23268737)
Clin Nephrol. 2006 Dec;66(6):447-54. (PMID: 17176917)
Clin Nephrol. 2004 Aug;62(2):144-8. (PMID: 15356972)
Intern Med. 2012;51(18):2587-90. (PMID: 22989831)
Clin Rheumatol. 2007 Apr;26(4):590-5. (PMID: 16440133)
Clin Exp Rheumatol. 1994 Mar-Apr;12(2):203-4. (PMID: 8039291)
Cardiology. 2009;114(3):208-11. (PMID: 19602882)
Clin Rheumatol. 2010 Aug;29(8):893-904. (PMID: 20306213)
Lancet. 2006 Jul 29;368(9533):404-18. (PMID: 16876669)
Clin Nephrol. 2006 Sep;66(3):202-9. (PMID: 16995343)
Heart Lung. 2003 Mar-Apr;32(2):140-3. (PMID: 12734537)
J Clin Rheumatol. 2008 Feb;14(1):38-40. (PMID: 18431098)
Mod Rheumatol. 2011 Oct;21(5):536-41. (PMID: 21400245)
J Rheumatol. 2011 Jul;38(7):1527-8. (PMID: 21724732)
Clin Infect Dis. 2000 Apr;30(4):633-8. (PMID: 10770721)
Nephrol Dial Transplant. 1998 Aug;13(8):2142-6. (PMID: 9719187)
Arthritis Rheum. 2000 Jan;43(1):226-31. (PMID: 10643719)
Lancet. 1991 Mar 30;337(8744):799-800. (PMID: 1672428)

0 (Antibodies, Antineutrophil Cytoplasmic)

Date Created: 20140304 Date Completed: 20150122 Latest Revision: 20220330

20221213

PMC3934949

10.1371/journal.pone.0089777

24587028