Granulomatosis with Polyangiitis (Wegener Granulomatosis) Mimicking Infective Endocarditis

  • Imène Rachdi Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis
  • Lilia Baili Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis
  • Fatma Daoud Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis
  • Zohra Aydi Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis
  • Hana Zoubeidi Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis
  • Basma Ben Dhaou Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis
  • Fatma Boussema Department of Internal Medicine, Habib Thameur Hospital, University El Manar, Tunis

Abstract

Introduction: Infective endocarditis (IE) has been reported to mimic granulomatosis with polyangiitis (GPA) and to test positive to antineutrophil cytoplasmic antibodies (ANCA), which may lead to a misdiagnosis and inappropriate treatment.

Case presentation: We report a case of a 59-year-old man admitted for purpura, gangrenous digital infarcts and glomerulonephritis. The diagnosis of IE was initially considered on the basis of heart murmur and two positive haemocultures to corynebacterium. Ineffectiveness of antimicrobial therapy and further neurological and nasal manifestations supported the diagnosis of GPA.

Conclusions: IE should be ruled out before initiation of immunosuppressive treatment. If the disease progresses despite antimicrobial treatment, vascular diseases should be rapidly taken into account in differential diagnosis and treated early to avoid fatal complications.

VIEW THE ENTIRE ARTICLE

References

  • Subra JF, Michelet C, Laporte J, et al. The presence of cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) in the course of subacute bacterial endocarditis with glomerular involvement, coincidence or association? Clin Nephrol. 1998, 49:15–18.

  • Calachanis M, Ferrero P, Orzan F, Marchisio F, Trevi G. Vasculitis mimicking bacterial endocarditis. Ital Heart J. 2003; 11: 816-8.

  • Anthony DD, Askari AD, Wolpaw T, McComsey G. Wegener granulomatosis simulating bacterial endocarditis. Arch Intern Med. 1999; 159:1807-10.

  • Sugiyama H, Sahara M, Imai Y, et al. Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis. Cardiology. 2009; 114:208-11.

  • Chirinos JA, Corrales-Medina VF, Garcia S, Lichtstein DM, Bisno AL, Chakko S. Endocarditis associated with antineutrophil cytoplasmic antibodies: a case report and review of the literature. Clin Rheumatol. 2007; 26:590-5.

  • Cheung CY, Wong KM, Chan YH, Chak WL, et al. False positive antineutrophil cytoplasmic antibody in a patient with infective endocarditis. Hong Kong Journal of Nephrology. 2001; 3:41-4.

  • Bonaci-Nikolic B, Andrejevic S, Pavlovic M, Dimcic Z, Ivanovic B, Nikolic M. Prolonged infections associated with antineutrophil cytoplasmic antibodies specific to proteinase 3 and myeloperoxidase: diagnostic and therapeutic challenge. Clin Rheumatol. 2010, 29:893–904.

  • Fukasawa H, Hayashi M, Kinoshita N, et al. Rapidly progressive glomerulonephritis associated with PR3-ANCA positive subacute bacterial endocarditis. Intern Med. 2012; 51:2587-90.

  • Tiliakos AM, Tiliakos NA. Dual ANCA Positivity in Subacute Bacterial Endocarditis. J Clin Rheumatol 2008; 14:38–40.

  • Hoffman G.S, Kerr G.S, Leavitt R.Y et al. Wegener granulomatosis: an analysis of 158 patients. Ann. Intern. Med. 1992; 116:488–98.
  • Published: 2014-10-02

    Issue: Vol 1 (2014) (view)

    Section: Articles

    How to cite:
    Rachdi, I., Baili, L., Daoud, F., Aydi, Z., Zoubeidi, H., Ben Dhaou, B., & Boussema, F. (2014). Granulomatosis with Polyangiitis (Wegener Granulomatosis) Mimicking Infective Endocarditis. European Journal of Case Reports in Internal Medicine, 1(1). https://doi.org/https://doi.org/10.12890/2014_000116

    Most read articles by the same author(s)