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

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 wa...

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Bibliographic Details
Published in:PloS one 2014-02, Vol.9 (2), p.e89777-e89777
Main Authors: Ying, Chun-Mei, Yao, Dong-Ting, Ding, Hui-Hua, Yang, Cheng-De
Format: Article
Language:English
Subjects:
Adult
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis
Antibodies
Antibodies, Antineutrophil Cytoplasmic - blood
Antibodies, Antineutrophil Cytoplasmic - immunology
Antigens
Antineutrophil cytoplasmic antibodies
Arthralgia
Biology
Blood tests
China - epidemiology
Diagnosis, Differential
Disease
Edema
Endocarditis
Endocarditis - diagnosis
Endocarditis - epidemiology
Endocarditis - immunology
Endocarditis - pathology
Enzyme-Linked Immunosorbent Assay
Exanthema
Extremities
Female
Fever
Health aspects
Hospitals
Humans
Immunoglobulins
Immunosuppressive agents
Infections
Infective endocarditis
Kaplan-Meier Estimate
L-Lactate dehydrogenase
Laboratories
Lactate dehydrogenase
Lactic acid
Literature reviews
Male
Medical research
Medicine
Middle Aged
Patients
Peroxidase
Prevalence
Proteinase
Proteinase 3
Rheumatology
Skin
Skin diseases
Vasculitis
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Summary: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. 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. 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. 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0089777