Dual ANCA positivity in subacute bacterial endocarditis

J Clin Rheumatol. 2008 Feb;14(1):38-40. doi: 10.1097/RHU.0b013e318164187a.


Nine cases of subacute bacterial endocarditis (SBE) associated with anti-PR3 ANCA have been described in the literature to date. We describe 2 cases of SBE associated with dual ANCA positivity (anti-PR3 and anti-MPO ANCA.) To our knowledge, these are the first such reported cases. One case was associated with cutaneous vasculitis, and the second with predisposing factors for SBE. ANCA titers resolved or decreased in both during initial corticosteroid therapy for suspected vasculitis. Follow-up of these patients revealed no evidence of the common ANCA associations such as Wegener granulomatosis. Rheumatologists, if aware of ANCA association with SBE, can avoid inappropriate immunosuppressive treatments.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Antibodies, Antineutrophil Cytoplasmic / drug effects
  • Antibodies, Antineutrophil Cytoplasmic / immunology*
  • Echocardiography, Transesophageal
  • Endocarditis, Subacute Bacterial / complications*
  • Endocarditis, Subacute Bacterial / diagnostic imaging
  • Endocarditis, Subacute Bacterial / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Streptococcal Infections / complications*
  • Streptococcal Infections / drug therapy
  • Vasculitis / complications*
  • Vasculitis / drug therapy
  • Vasculitis / immunology
  • Viridans Streptococci / drug effects
  • Viridans Streptococci / pathogenicity*


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • Antibodies, Antineutrophil Cytoplasmic