Antineutrophil cytoplasmic autoantibody-negative antiproteinase 3 syndrome presenting as vasculitis, endocarditis, polyneuropathy and Dupuytren's contracture

J Heart Valve Dis. 2003 Jul;12(4):530-4.


Antiproteinase 3 antibodies (antiPR3) are assumed to be subtypes of antineutrophil cytoplasmic autoantibodies (ANCA), with a high specificity for active Wegener's granulomatosis and microscopic polyangiitis. Thus, antiPR3 positivity in ELISA, together with negativity in indirect immunofluorescence (IIF) is a rare finding. A 56-year-old man with Dupuytren's contracture and polyneuropathy was admitted for leukocytoclastic vasculitis. Echocardiography, performed because of fever and dyspnea, detected aortic valve endocarditis. Because of severe aortic insufficiency the valve was replaced. Blood cultures and bacteriologic investigations of the explanted valve were negative. AntiPR3 were elevated (123-163 U/ml; normal <6 U/ml), together with negativity in IIF. This case shows that antiPR3 elevation with negative ANCA may be associated with vasculitis, endocarditis, polyneuropathy and Dupuytren's contracture. A causal relationship between the clinical presentation and antiPR3 elevation is likely. In order not to miss such cases of vasculitis, combined screening by IIF and ELISA is recommended in selected cases.

Publication types

  • Evaluation Study

MeSH terms

  • Antibodies, Antineutrophil Cytoplasmic*
  • Aortic Valve Insufficiency / diagnosis
  • Aortic Valve Insufficiency / microbiology
  • Aortic Valve Insufficiency / surgery
  • Diagnosis, Differential
  • Dupuytren Contracture / diagnosis*
  • Dupuytren Contracture / microbiology
  • Echocardiography
  • Endocarditis, Bacterial / diagnosis*
  • Endocarditis, Bacterial / microbiology
  • Fluorescent Antibody Technique, Indirect
  • Heart Valve Prosthesis Implantation
  • Humans
  • Male
  • Middle Aged
  • Polyneuropathies / diagnosis*
  • Polyneuropathies / microbiology
  • Syndrome
  • Treponema pallidum
  • Vasculitis, Leukocytoclastic, Cutaneous / diagnosis*
  • Vasculitis, Leukocytoclastic, Cutaneous / microbiology


  • Antibodies, Antineutrophil Cytoplasmic