Positive Cytoplasmic Antineutrophil Cytoplasmic Antigen with PR3 Specificity Glomerulonephritis in a Patient with Subacute Bacterial Endocarditis

To the Editor: A 28-year-old man presented with 4 weeks of malaise, 1 week of progressive bilateral leg edema, hematuria, and 2 days of dyspnea and orthopnea. There were no other symptoms. He had chronic hepatitis C and a remote history of asthma. He smoked crack cocaine, marijuana, and cigarettes, but denied intravenous drug or alcohol use. His medical history was otherwise unremarkable and he was not taking any medications. He denied recent dental work. The patient appeared weak and ill. His initial temperature was 36°C and he remained afebrile. Pulse was 115 beats per minute. Significant physical findings included clubbing, bilateral pitting edema past the knees, jugular venous distension, ascites, and bilateral pulmonary crackles. Cardiac auscultation demonstrated an S3, a diastolic murmur along the left sternal border, and a systolic murmur at the apex. There were no dermatologic manifestations, nasopharyngeal abnormalities, or inflamed joints. Laboratory data revealed a leukocyte count of 25.3 × 103/mm3, neutrophils 20.7 × 103/mm3, lymphocytes 1.3 × 103/mm3, eosinophils 0.3 × 103/mm3, hemoglobin 80 g/l, platelets 360 × 10 … Address correspondence to Dr. M. Uh, 304-2828 Yew Street, Vancouver, BC V6K 4W5, Canada. E-mail: uhm{at}interchange.ubc.ca