Authors: Branka BonaciNikolic Sladjana Andrejevic Milorad Pavlovic Zoran Dimcic Branislava Ivanovic Milos Nikolic
Publish Date: 2010/03/20
Volume: 29, Issue: 8, Pages: 893-904
Abstract
Chronic infections may mimic antineutrophil cytoplasmic antibody ANCAassociated vasculitides AAV We investigated which markers may help in the diagnosis and the prognosis of infections associated with proteinase 3 PR3 and myeloperoxidase MPOANCA In this study 1993–2008—with an average followup of 51 years—we compared 66 AAV patients with 17 PR3 and/or MPOANCApositive patients with protracted bacterial 11/17 or viral 6/17 infections Seven of 17 patients had subacute bacterial endocarditis SBE while six of 17 patients had various autoimmune manifestations of chronic hepatitis C virus HCV infection We determined ANCA antinuclear antibodies antiPR3 antiMPO anticardiolipin aCL antibeta 2 glycoprotein I β2GP I cryoglobulins C3 and C4 Patients with infections were younger than AAV patients p 001 There was no difference in frequency of renal and skin lesions AAV patients more frequently had pulmonary and nervous system manifestations p 001 Patients with infections more frequently had dual ANCA high PR3 low MPO aCL antiβ2GP I cryoglobulins and hypocomplementemia p 0001 Immunosuppressive therapy IST was used in five 17 patients who had persistently high ANCA cryoglobulinemia and hypocomplementemia There was no difference in frequency of lethality and renal failure in the two study groups In patients who are PR3 and/or MPOANCA positive SBE and HCV infection should be excluded Although similar in renal and skin manifestations in comparison to AAV only patients with infections developed multiple serological abnormalities In patients with infections concomitant presence of ANCA cryoglobulins and hypocomplementemia was associated with severe glomerulonephritis The serological profile should be repeated after specific antimicrobial or surgical therapy since some cases might require IST
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