1/3. Subacute bacterial endocarditis with positive cytoplasmic antineutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies.OBJECTIVE: To report a potentially important limitation of antineutrophil cytoplasmic antibody (ANCA) testing: positive results in patients with subacute bacterial endocarditis (SBE). methods: We describe 3 patients with SBE who presented with features mimicking ANCA-associated vasculitis (AAV) and positive findings on tests for cytoplasmic ANCA (cANCA) by indirect immunofluorescence and for anti-proteinase 3 (anti-PR3)antibodies by antigen-specific enzyme-linked immunosorbent assay (ELISA). We also reviewed the published literature describing infectious diseases with (misinterpreted) positive ANCA results through a medline search of English-language articles published between 1966 and January 1999. These previously reported cases were reinterpreted using an ANCA scoring system that combines the findings of immunofluorescence and antigen-specific ELISA testing. RESULTS: We are now aware of a total of 7 cases of SBE with positive cANCA and anti-PR3 antibodies. We are not aware of any cases of SBE associated with antimyeloperoxidase/perinuclear ANCA. Clinical manifestations mimicking AAV included glomerulonephritis, purpura, epistaxis, or sinus symptoms in 6 of the patients. Streptococcal species were identified in 5 patients, and cardiac valvular abnormalities were demonstrated in 6. All patients except 1, who died of a complication of SBE, recovered with antibiotic therapy. CONCLUSION: Findings of tests for anti-PR3/ cANCA antibodies may be positive in patients with SBE. When encountering ANCA positivity in patients suspected of having systemic vasculitis, physicians should take appropriate steps to rule out infectious diseases, including SBE, before committing the patient to long-term, aggressive immunosuppressive therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Fatal myocardial infarction resulting from coronary artery septic embolism after abortion: unusual cause and complication of endocarditis.Significant medical complications after elective abortion are rare. However, complications do occur, and the emergency physician should always bear this in mind when evaluating a patient with significant illness who has recently undergone an elective abortion. Reported here is a case of postabortion endocarditis, manifesting as a septic coronary artery embolism, that led to a fatal acute myocardial infarction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis.Janeway's lesions and Osler's nodes are regarded as excellent clues to the diagnosis of infectious endocarditis; however, very few physicians have actually witnessed these findings, and there is some confusion in distingushing between the two. This article concerns a patient with infectious endocarditis due to Diplococcus pneumoniae, who had tender vesicular lesions thought to be Osler's nodes and a nontender erythematous nodule on the foot compatible with a Janeway's lesion. The original comments by William Osler and Edward Janeway are presented, and the literature following their descriptions is reviewed. It is concluded that the only essential diagnostic difference between the two is the tenderness that is associated with an Osler's node but not with a Janeway's lesion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |