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Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review

RATIONALE: In the course of endocarditis, the development of antineutrophil cytoplasmic antibody (ANCA)-mediated disease introduces the dilemma of determining the best treatment approach for immune conditions, whether immunosuppressant therapy should be added to antibiotic treatment has remained con...

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Autores principales: Shi, Xiao-dong, Li, Wan-yu, Shao, Xue, Qu, Li-mei, Jiang, Zhen-yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373528/
https://www.ncbi.nlm.nih.gov/pubmed/32702934
http://dx.doi.org/10.1097/MD.0000000000021358
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author Shi, Xiao-dong
Li, Wan-yu
Shao, Xue
Qu, Li-mei
Jiang, Zhen-yu
author_facet Shi, Xiao-dong
Li, Wan-yu
Shao, Xue
Qu, Li-mei
Jiang, Zhen-yu
author_sort Shi, Xiao-dong
collection PubMed
description RATIONALE: In the course of endocarditis, the development of antineutrophil cytoplasmic antibody (ANCA)-mediated disease introduces the dilemma of determining the best treatment approach for immune conditions, whether immunosuppressant therapy should be added to antibiotic treatment has remained controversial. PATIENT CONCERNS: A 33-year-old man presented with progressive fever lasting for 7 months, and swelling, pain, and purpura in the arms and legs. The patient showed multiple autoantibodies including cytoplasmic ANCA, antiproteinase 3, rheumatoid factor, and anti-beta 2 glycoprotein I. Blood culture was positive for viridans streptococcus, and renal biopsy revealed glomerulonephritis and interstitial nephritis. DIAGNOSIS: Endocarditis caused by viridans streptococci, ANCA-associated vasculitis, and congenital ventricular septal defect. INTERVENTIONS: In addition to effective antibiotics, he also received twice intravenous corticosteroids and intravenous immunoglobulin therapy, and a low dose of cyclophosphamide. At last, the patient received congenital ventricular septal defect repair and debridement. OUTCOMES: The abnormal clinical manifestations, including renal failure and loss of strength, recovered rapidly with corticosteroid therapy in addition to antibiotic treatment. After 6 months without any medications, he remained asymptomatic and was able to live normally. LESSONS: In this case with endocarditis and ANCA-associated vasculitis, we highlighted the importance of biopsy and immunosuppressive therapy. Histopathologic examination is required for diagnosis and treatment in such case. Identifying patients who have endocarditis and ANCA positivity with vasculitis pathologic features will require corticosteroid/immunosuppressives in addition to the antibiotics therapy.
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spelling pubmed-73735282020-08-05 Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review Shi, Xiao-dong Li, Wan-yu Shao, Xue Qu, Li-mei Jiang, Zhen-yu Medicine (Baltimore) 6900 RATIONALE: In the course of endocarditis, the development of antineutrophil cytoplasmic antibody (ANCA)-mediated disease introduces the dilemma of determining the best treatment approach for immune conditions, whether immunosuppressant therapy should be added to antibiotic treatment has remained controversial. PATIENT CONCERNS: A 33-year-old man presented with progressive fever lasting for 7 months, and swelling, pain, and purpura in the arms and legs. The patient showed multiple autoantibodies including cytoplasmic ANCA, antiproteinase 3, rheumatoid factor, and anti-beta 2 glycoprotein I. Blood culture was positive for viridans streptococcus, and renal biopsy revealed glomerulonephritis and interstitial nephritis. DIAGNOSIS: Endocarditis caused by viridans streptococci, ANCA-associated vasculitis, and congenital ventricular septal defect. INTERVENTIONS: In addition to effective antibiotics, he also received twice intravenous corticosteroids and intravenous immunoglobulin therapy, and a low dose of cyclophosphamide. At last, the patient received congenital ventricular septal defect repair and debridement. OUTCOMES: The abnormal clinical manifestations, including renal failure and loss of strength, recovered rapidly with corticosteroid therapy in addition to antibiotic treatment. After 6 months without any medications, he remained asymptomatic and was able to live normally. LESSONS: In this case with endocarditis and ANCA-associated vasculitis, we highlighted the importance of biopsy and immunosuppressive therapy. Histopathologic examination is required for diagnosis and treatment in such case. Identifying patients who have endocarditis and ANCA positivity with vasculitis pathologic features will require corticosteroid/immunosuppressives in addition to the antibiotics therapy. Wolters Kluwer Health 2020-07-17 /pmc/articles/PMC7373528/ /pubmed/32702934 http://dx.doi.org/10.1097/MD.0000000000021358 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 6900
Shi, Xiao-dong
Li, Wan-yu
Shao, Xue
Qu, Li-mei
Jiang, Zhen-yu
Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review
title Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review
title_full Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review
title_fullStr Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review
title_full_unstemmed Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review
title_short Infective endocarditis mimicking ANCA-associated vasculitis: does it require immunosuppressive therapy?: A case report and literature review
title_sort infective endocarditis mimicking anca-associated vasculitis: does it require immunosuppressive therapy?: a case report and literature review
topic 6900
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373528/
https://www.ncbi.nlm.nih.gov/pubmed/32702934
http://dx.doi.org/10.1097/MD.0000000000021358
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