A 39 year old Man with Infective Endocarditis with Positive Antineutrophil Cytoplasmic

Antibodies (ANCA) : A Case Report

Roni A. T., A. Afif Siregar, Zulfikri M., Nizam A., Aldino S. A.
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of North
Sumatra/ Haji Adam Malik Hospital, Medan
ABSTRACT
Background
Infective endocarditis triggers the development of multiple immunological reactions, including
the formation of autoantibodies. Certain categories of autoantibodies triggered by endocarditis,
for example, antineutrophil cytoplamic antibodies (ANCA), may cause secondary diseases that
require special diagnostic approaches and at times special interventions. Formation of ANCA
secondary to endocarditis has been linked to vasculitis and renal disease.
Case Report
We report a case of an Indonesian man with symptoms peteckie on his extremities. This
condition has been experienced since a year ago. History of progressive breathlessness,
arthralgia, and fever were found. Physical examination showed a grade 3/6 PSM in apex to
axilla and a grade 3/4 EDM in ULSB. The ECG showed sinus rhytm with LVH. The CXR
showed cardiomegaly and congestion. TTE found vegetations in aortic and pulmonal valves.
Medication in ward were ceftriaxone, gentamycin, furosemide, Aspar K and Ascorbid Acid. His
previous treatmeant was in Island Hospital in Penang with intial working diagnosis was an
ANCA associated vasculitis. He was noted to have a positif ANCA/PR3 and was commenced on
prednisolone, cellcept and imuran by his consultant haematologist in Indonesia. He has been on
this concortion of immunosuppression for a year. His blood test show that he has renal
impairment. He had a renal biopsy with conclusion vasculitic nephropathy. Blood cultures in 3
sets were all positive for a gram positive cocci/alpha haemolytic streptococcus. After further
examination, this patient was diagnosed with subacute bacterial endocarditis.
Conclusion
A patient presents with fever, arthralgia, petekie and the ANCA test positive, appropriate steps
should be taken to exclude infection (especially IE) before confirming the diagnosis of ANCAassociated vasculitis and embarking on long-term immunosuppressive therapy.
Key words antineutrophil cytoplasmic antibodies

infective endocarditis

vasculitis