Abstract
ObjectiveChronic 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.MethodsA 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.Resultswe 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.ConclusionTherefore, 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.
Highlights
Antineutrophil cytoplasmic antibodies (ANCAs) directed against proteinase-3 (PR3) or myeloperoxidase (MPO) are important diagnostic markers for small small-vessel vasculitic syndromes (i.e. Granulomatosis with polyangiitis, microscopic polyangiitis, Eosinophilic granulomatosis and polyangiitis), which are commonly referred to as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [1]
Several infectious diseases, infective endocarditis (IE), have been reported to exhibit positive ANCA tests and to mimic AAV, which may lead to a misdiagnosis and inappropriate treatment [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]
Fever was the most common symptom: it was observed in all ANCA-positive IE and 22 (84.6%) of ANCA-negative IE cases
Summary
Antineutrophil cytoplasmic antibodies (ANCAs) directed against proteinase-3 (PR3) or myeloperoxidase (MPO) are important diagnostic markers for small small-vessel vasculitic syndromes (i.e. Granulomatosis with polyangiitis, microscopic polyangiitis, Eosinophilic granulomatosis and polyangiitis), which are commonly referred to as ANCA-associated vasculitis (AAV) [1]. Several infectious diseases, infective endocarditis (IE), have been reported to exhibit positive ANCA tests and to mimic AAV, which may lead to a misdiagnosis and inappropriate treatment [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. We describe 13 patients with IE who had positive findings upon testing for ANCA by an antigen-specific enzymelinked immunosorbent assay (ELISA). We compared those findings with 26 ANCA-negative patients as well as cases reported in the literature
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