A Case of Sub-acute Bacterial Endocarditis associated with a Positive ANCA Serology

Korean Journal of Nephrology 2008;27(4):476-480.

Jun-Ho Choi, M.D., Duk Eun Jung, M.D., Han Seung Ryu, M.D., Hyeon Jeong Kim, M.D., Yu Min Lee, M.D., Jae Hun Lee, M.D., Ji Eun Lee, M.D., Jin Ho Shin, M.D., Ju Hung Song, M.D. and Seon Ho Ahn, M.D.

Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea

증례 : 혈청 항중성구세포질항체 (ANCA) 양성으로 발현한 아급성 심내막염 1예

최준호, 정덕은, 류한승, 김현정, 이유민, 이재훈, 이지은, 신진호, 송주흥, 안선호

원광대학교 의과대학 내과학교실

Abstract

Antineutrophil cytoplasmic antibodies (ANCA) directed against either proteinase-3 or myeloperoxidase are associated with a limited group of small vessel vasculitic syndromes. C-ANCA is regarded as highly specific for idiopathic ANCA-associated vasculitis (AAV). However, C-ANCA is not specific for Wegeners granulomatosis and has been reported in the course of a variety of infectious conditions. Sub-acute bacterial endocarditis is a notable concern because it may be associated with C-ANCA. The misdiagnosis of bacterial endocarditis as AAV and the administration of immunosuppressive treatment could aggravate the infection. We describe a patient with sub-acute bacterial endocarditis who presented with features mimicking vasculitis and positive C-ANCA by indirect immunofluorescence and for anti-PR3 antibodies by antigen-specific ELISA.

Key Words: Sub-acute bacterial endocarditis, ANCA, Vasculitis