Proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by infectious endocarditis: a case report.
BACKGROUND
Proteinase 3-antineutrophil cytoplasmic antibody has been reported to be positive in 5-10% of cases of renal injury complicated by infective endocarditis; however, histological findings have rarely been reported for these cases.


CASE PRESENTATION
A 71-year-old Japanese man with a history of aortic valve replacement developed rapidly progressive renal dysfunction with gross hematuria and proteinuria. Blood analysis showed a high proteinase 3-antineutrophil cytoplasmic antibody (163 IU/ml) titer. Streptococcus species was detected from two separate blood culture bottles. Transesophageal echocardiography detected mitral valve vegetation. Histological evaluation of renal biopsy specimens showed necrosis and cellular crescents in glomeruli without immune complex deposition. The patient met the modified Duke criteria for definitive infective endocarditis. On the basis of these findings, the patient was diagnosed with proteinase 3-antineutrophil cytoplasmic antibody-positive necrotizing crescentic glomerulonephritis complicated by Streptococcus infective endocarditis. His renal disease improved, and his proteinase 3-antineutrophil cytoplasmic antibody titer normalized with antibiotic monotherapy.


CONCLUSION
Few case reports have described histological findings of proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis. We believe that an accumulation of histological findings and treatments is mandatory for establishment of optimal management for proteinase 3-antineutrophil cytoplasmic antibody-positive renal injury complicated with infective endocarditis.
['Yanai|Katsunori|K|', 'Kaku|Yoshio|Y|', 'Hirai|Keiji|K|', 'Kaneko|Shohei|S|', 'Minato|Saori|S|', 'Mutsuyoshi|Yuko|Y|', 'Ishii|Hiroki|H|', 'Kitano|Taisuke|T|', 'Shindo|Mitsutoshi|M|', 'Miyazawa|Haruhisa|H|', 'Ito|Kiyonori|K|', 'Ueda|Yuichiro|Y|', 'Hiruta|Masahiro|M|', 'Ookawara|Susumu|S|', 'Ueda|Yoshihiko|Y|', 'Morishita|Yoshiyuki|Y|']
D000368:Aged D000900:Anti-Bacterial Agents D019268:Antibodies, Antineutrophil Cytoplasmic D004696:Endocarditis D005921:Glomerulonephritis D006801:Humans D007668:Kidney D008297:Male D053146:Myeloblastin D013290:Streptococcal Infections
Necrotizing crescentic glomerulonephritis Proteinase 3-antineutrophil cytoplasmic antibody Infective endocarditis