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Gemella sanguinis endocarditis with c-ANCA/anti-PR-3-associated immune complex necrotizing glomerulonephritis with a 'full-house' pattern on immunofluorescence microscopy.

Rousseau-Gagnon M, Riopel J, Desjardins A, Garceau D, Agharazii M, Desmeules S - Clin Kidney J (2013)

Bottom Line: Echocardiography and blood cultures growing Gemella sanguinis diagnosed endocarditis.Dialysis was required for a month.Three months later, following valve replacement, glucocorticoids and 2 months of antibiotic therapy, the creatinine level decreased to 62 µmol/L and c-ANCA/anti-PR3 disappeared.

View Article: PubMed Central - PubMed

Affiliation: Service of Nephrology , CHUQ-Hôtel-Dieu de Québec , Quebec , Canada.

ABSTRACT
A 67-year-old man was evaluated for haematuria, with a rising creatinine level from 88 to 906 µmol/L and positive c-anti-neutrophil cytoplasm antibody (ANCA)/anti-proteinase 3 (anti-PR3). A kidney biopsy revealed necrotizing glomerulonephritis with a 'full-house' pattern on immunofluorescence microscopy. Echocardiography and blood cultures growing Gemella sanguinis diagnosed endocarditis. Dialysis was required for a month. Three months later, following valve replacement, glucocorticoids and 2 months of antibiotic therapy, the creatinine level decreased to 62 µmol/L and c-ANCA/anti-PR3 disappeared. This first case of c-ANCA/anti-PR3 positive glomerulonephritis with a 'full-house' immunofluorescence pattern due to bacterial endocarditis underlines the importance of ruling out infection with ANCA positivity or kidney biopsy suggestive of lupus nephritis.

No MeSH data available.


Related in: MedlinePlus

Electron microscopy of glomerulus. Mesangial (#) and subendothelial immune complex deposits (*) with mesangial cell interposition (electron microscopy).
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SFT030F3: Electron microscopy of glomerulus. Mesangial (#) and subendothelial immune complex deposits (*) with mesangial cell interposition (electron microscopy).

Mentions: Haemodialysis was required on the second day of admission. Transthoracic echocardiography showed severe mitral regurgitation with a 9 × 27 mm pannus and a 4-mm vegetation attached to the anterior mitral leaflet, with multiple microperforations. The transoesophageal echocardiography confirmed severe mitral regurgitation with an 11 × 13 mm vegetation on the anterior leaflet, and moderate aortic and tricuspid regurgitation. A kidney biopsy revealed focal necrotizing glomerulonephritis without significant endocapillary or mesangial proliferation (Figure 1). The glomeruli showed cellular crescents (4/21) and/or fibrinoid necrosis (3/21) with mildly increased mesangial matrix. The tubulointerstitial compartment revealed mild tubular atrophy and moderate-to-severe interstitial oedema. Severe acute tubular injury was also present. Vessels showed nothing but focally severe arteriosclerosis. Immunofluorescence microscopy revealed primarily mesangial immune complex deposits with focal capillary loop involvement in a full-house pattern with strongly positive C3, IgM and C1q, moderately positive IgG and mildly positive IgA (Figure 2). Electron microscopy showed subendothelial (Figure 3) and mesangial electron dense deposits with focal mesangial interposition. No tubuloreticular inclusions were found. In the context of a probable endocarditis, ceftriaxone and gentamicin were started, and methylprednisolone 500 mg IV ID was given for 3 days followed by daily prednisone (50 mg) for 2 weeks in an attempt to treat the necrotizing glomerulonephritis.Fig. 1.


Gemella sanguinis endocarditis with c-ANCA/anti-PR-3-associated immune complex necrotizing glomerulonephritis with a 'full-house' pattern on immunofluorescence microscopy.

Rousseau-Gagnon M, Riopel J, Desjardins A, Garceau D, Agharazii M, Desmeules S - Clin Kidney J (2013)

Electron microscopy of glomerulus. Mesangial (#) and subendothelial immune complex deposits (*) with mesangial cell interposition (electron microscopy).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400477&req=5

SFT030F3: Electron microscopy of glomerulus. Mesangial (#) and subendothelial immune complex deposits (*) with mesangial cell interposition (electron microscopy).
Mentions: Haemodialysis was required on the second day of admission. Transthoracic echocardiography showed severe mitral regurgitation with a 9 × 27 mm pannus and a 4-mm vegetation attached to the anterior mitral leaflet, with multiple microperforations. The transoesophageal echocardiography confirmed severe mitral regurgitation with an 11 × 13 mm vegetation on the anterior leaflet, and moderate aortic and tricuspid regurgitation. A kidney biopsy revealed focal necrotizing glomerulonephritis without significant endocapillary or mesangial proliferation (Figure 1). The glomeruli showed cellular crescents (4/21) and/or fibrinoid necrosis (3/21) with mildly increased mesangial matrix. The tubulointerstitial compartment revealed mild tubular atrophy and moderate-to-severe interstitial oedema. Severe acute tubular injury was also present. Vessels showed nothing but focally severe arteriosclerosis. Immunofluorescence microscopy revealed primarily mesangial immune complex deposits with focal capillary loop involvement in a full-house pattern with strongly positive C3, IgM and C1q, moderately positive IgG and mildly positive IgA (Figure 2). Electron microscopy showed subendothelial (Figure 3) and mesangial electron dense deposits with focal mesangial interposition. No tubuloreticular inclusions were found. In the context of a probable endocarditis, ceftriaxone and gentamicin were started, and methylprednisolone 500 mg IV ID was given for 3 days followed by daily prednisone (50 mg) for 2 weeks in an attempt to treat the necrotizing glomerulonephritis.Fig. 1.

Bottom Line: Echocardiography and blood cultures growing Gemella sanguinis diagnosed endocarditis.Dialysis was required for a month.Three months later, following valve replacement, glucocorticoids and 2 months of antibiotic therapy, the creatinine level decreased to 62 µmol/L and c-ANCA/anti-PR3 disappeared.

View Article: PubMed Central - PubMed

Affiliation: Service of Nephrology , CHUQ-Hôtel-Dieu de Québec , Quebec , Canada.

ABSTRACT
A 67-year-old man was evaluated for haematuria, with a rising creatinine level from 88 to 906 µmol/L and positive c-anti-neutrophil cytoplasm antibody (ANCA)/anti-proteinase 3 (anti-PR3). A kidney biopsy revealed necrotizing glomerulonephritis with a 'full-house' pattern on immunofluorescence microscopy. Echocardiography and blood cultures growing Gemella sanguinis diagnosed endocarditis. Dialysis was required for a month. Three months later, following valve replacement, glucocorticoids and 2 months of antibiotic therapy, the creatinine level decreased to 62 µmol/L and c-ANCA/anti-PR3 disappeared. This first case of c-ANCA/anti-PR3 positive glomerulonephritis with a 'full-house' immunofluorescence pattern due to bacterial endocarditis underlines the importance of ruling out infection with ANCA positivity or kidney biopsy suggestive of lupus nephritis.

No MeSH data available.


Related in: MedlinePlus