Journal of Yeungnam Medical Science

Case Reports

C-ANCA-positive glomerulonephritis associated with subacute infective endocarditis caused by Bartonella infection: Min Jeong Kim, Ha Nee Jang, Tae Won Lee, Hyun Seop Cho, Se Ho Chang, Hyun Jung Kim; Yeungnam Univ J Med. 2017;34(1):140-145. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.140

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Glomerulonephritis (GN) is sometimes associated with infective endocarditis (IE). Bartonella endocarditis is difficult to diagnose because it is rare and cannot be detected by blood culture. This is the first report of cytoplasmic anti-neutrophil cytoplasmic antibody-positive subacute endocarditis-associated GN caused by Bartonella infection in South Korea. A 67-year-old man was hospitalized due to azotemia. He complained of weight loss and anorexia for 6 months. A diagnosis of IE was made based upon echocardiographic detection of vegetations on the mitral and aortic valves and a Bartonella antibody titer of 1:2,048. Renal histology identified focal crescentic GN. Azotemia and proteinuria improved after doxycycline and rifampin treatment combining with steroid therapy.

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Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis – our experience and a pooled analysis
Mineaki Kitamura, Alana Dasgupta, Jonathan Henricks, Samir V. Parikh, Tibor Nadasdy, Edward Clark, Jose A. Bazan, Anjali A. Satoskar
Frontiers in Nephrology.2024;[Epub] CrossRef

A Case of ANCA-Negative Generalized Wegener's Granulomatosis.: Seung Kyu Kim, Yong Jin Kwon, Heae Surng Park, Kwang Won Rhee, Ji Yoon Ha, Hee Sung Ko, Ki Hyun Kim, Min Kwang Byun; Yeungnam Univ J Med. 2013;30(1):17-20. Published online June 30, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.1.17

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Abstract PDF: Wegener's granulomatosis is a very rare systemic vasculitis characterized by necrotizing granulomatosis. The detection of antineutrophil cytoplasm antibody (ANCA) is a valuable finding in diagnosing Wegener's granulomatosis because ANCA is positive in approximately 90 percent of patients with active, generalized Wegener's granulomatosis. But ANCA is not necessarily positive to make a diagnosis. A 59-year-old man was transferred to our hospital. He was diagnosed with lung abscess and treated with antibiotics at previous hospital. Initially, the ANCA was negative in immunofluorescence assay but we suspected Wegener's granulomatosis because of systemic inflammatory symptoms. Clinical symptoms deteriorated rapidly so we did bronchoscopic biopsy early. Wegener's granulomatosis was diagnosed according to pathologic finding that reported necrotizing granulomatous inflammation associated with vasculitis. Thus we treated with steroid then clinical symptoms and laboratory findings were improved.

A Case of Microscopic Polyangiitis with Diffuse Alveolar Hemorrhage.: Sang Jin Lee, Jae Woung Lee, Hye Jin Kim, Kyeong Cheol Shin, Jin Hong Chung, Kwan Ho Lee, Hye Jung Park; Yeungnam Univ J Med. 2004;21(1):101-107. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.101

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Abstract PDF: Diffuse alveolar hemorrhage is a rare but serious and frequently life-threatening complication of a variety of conditions. The first goal in the management of patients with diffuse alveolar hemorrhage is to achieve or preserve stability of the respiratory status. Subsequently, the differential diagnosis is aimed at the identification of a remediable cause of the alveolar hemorrhage. The most common causes of diffuse alveolar hemorrhage with glomerulonephritis are microscopic polyangiitis and Wegener's granulomatosis, followed by Goodpasture syndrome and systemic lupus erythematosus. Microscopic polyangiitis (MPA) is a distinct systemic small vessle vasculitis affecting small sized vessels with few or no immune deposits and with no granulomatosus inflammation. The disease may involve multiple organs such as kidney, lung, skin, joint, muscle, gastrointestinal tract, eye, and nervous system. MPA is strongly associated with antineutrophil cytoplasmic autoantibody (ANCA) that is a useful serological diagnostic marker for the most common form of necrotizing vasculitis. Our report concerns a case of microscopic polyangiitis with diffuse alveolar hemorrhage in a 54-year-old man. He was admitted to our hospital due to dyspnea upon exertion and recurrent hemoptysis. Laboratory findings showed hematuria, proteinuria and deterioration of renal function. In the chest CT scan, diffuse ground glass appearance was seen in both lower lungs. A lung biopsy revealed small vessel vasculitis with intraalveolar hemorrhage and showed a positive reaction to against perinuclear ANCA. The patient was treated with prednisolone and cyclophosphamide. Chest infiltration decreased and hemoptysis and hypoxia improved. He is still being followed up in our hospital with a low dose of prednisolone.

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