Vasculitis associated with septicemia: case report and review of the literature

• Published in: Pediatric nephrology (Berlin, West) Vol. 16; no. 12; pp. 1089 - 1092
• Main Authors: KODO, Kazuki, HIDA, Mariko, OMORI, Sayu, MORI, Tetsuya, TOKUMURA, Mitsuaki, KURAMOCHI, Shigeru, AWAZU, Midori
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-12-2001; Springer Nature B.V
• Subjects: Adolescent; Antigen-antibody complexes; Azathioprine; Bacteremia; Biological and medical sciences; Biopsy; Blood culture; Case reports; Coronary artery disease; Cryoglobulinemia; Differential diagnosis; Disease Progression; Endocarditis; Endocarditis, Bacterial - microbiology; Female; Fever; Glomerulonephritis; Glomerulonephritis - microbiology; Glomerulonephritis - pathology; Glomerulonephritis - physiopathology; Heart diseases; Hematuria; Humans; Hypergammaglobulinemia; Kidney - pathology; Literature reviews; Medical sciences; Nephrology. Urinary tract diseases; Prednisolone; Proteinuria; Purpura; Renal failure; Septicemia; Skin diseases; Streptococcal Infections; Streptococcus pyogenes; Systemic lupus erythematosus; Systemic vasculitis; Urinary lithiasis; Vasculitis - microbiology; Human; Kidney disease; Glomerulonephritis; Skin disease; Urinary system disease; Septicemia; Etiopathogenesis; Cardiovascular disease; Kidney; Urinary stone; Vascular disease; Case study; Vasculitis; Purpura; Heart disease; Endocardial disease; Adolescent; Endocarditis; Lithiasis; Capillary vessel disease; Complication; Diagnosis
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s004670100035

We report an unusual case in which infectious endocarditis presented systemic vasculitis and glomerulonephritis as the initial manifestation of the disease. The patient was a 16-year-old girl with congenital cyanotic heart disease who presented with skin purpura, proteinuria, and hematuria. She had hypergammaglobulinemia, cryoglobulinemia, and positive circulating immune complexes. Renal biopsy revealed crescentic glomerulonephritis. Her serum C3 level, which was initially normal, became decreased, and prednisolone and azathioprine were administered with a tentative diagnosis of systemic lupus erythematosus (SLE). Soon after, she developed fever and renal failure. Blood culture grew Streptococcus pyogenes, and the diagnosis of infectious endocarditis was made. Eight cases of systemic vasculitis and glomerulonephritis associated with infectious endocarditis have been described in the literature. Infectious endocarditis should be included in the differential diagnosis of systemic vasculitis and glomerulonephritis.