Infective endocarditis with positive anti-neutrophil cytoplasmic antibodies: three cases report with literature review / 中华风湿病学杂志

ABSTRACT

Objective To analyze the clinical features of infective endocarditis with positive antineutrophil cytoplasmic antibodies ,and compare with ANCA associated small vessel vasculitis(AASV). Methods Three IE patients with positive ANCA were analyzed, and 13 cases from literatures were reviewed. Results Sixteen patients had positive anti-PR3 ANCA, in which 2 cases had both positive (anti-PR3 and anti-MPO ANCA) ANCA. All patients had some clinical manifestations mimic AASV, including fever ( 13/16, 81% ), rash (8/16, 50% ), rapidly progressive glomerulonephritis (7/16, 44% ), splenomegaly (6/16, 38% ). Streptococcal species were identified in 12 patients, and cardiac valvular abnormalities were demonstrated in all patients. All patients except 2, who died of cerebral hemorrhage followed by cerebral infarction, recovered with antibiotic therapy. Conclusion Infective endocarditis sometimes can have the same clinical features as AASV, so physicians should carefully differentiate between them when dealing with patients with positive ANCA antibodies.