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INTRODUCTION:
Immunocomplex phenomenon are infrequent clinical manifestations of infectious endocarditis, therefore, this clinical scenario should be intentionally sought.
OBJECTIVE:
To describe a case of infective endocarditis manifested as rapidly progressive glomerulonephritis.
CASE PRESENTATION:
A 64-year-old man, with no chronic history. His current condition began three months ago, when he presented with edema of the lower extremities accompanied by chills and fever. In the emergency room he presented purpuric lesions located on the legs and a mesothelesystolic murmur III/VI in the aortic focus. In the paraclinical tests he presented leukocytosis with neutrophilia; acute kidney injury KDIGO 3 with hematuria of glomerular origin and an elevation six times his baseline creatinine manifesting as a rapidly progressive glomerulonephritis. Infectious etiologies were ruled out: Hepatitis B and C virus, HIV; electrophoresis and immunofixation in blood and urine, immunological studies (cryoglobulins, ANAs, ANCAs and anti-glomerular basement membrane antibodies), which were negative, he only presented C3 and C4 consumption. Renal biopsy was performed reporting: "membranoproliferative glomerulonephritis due to immune complexes, with focal active extracapillary proliferation and intra glomerular hyaline thrombi". During her hospitalization, serial blood cultures were performed, reporting Enterococcus faecium. A transthoracic echocardiogram was requested with high probability for endocarditis and severe aortic insufficiency. Supportive treatment was started and he was referred to a Cardiology Center for surgical valve replacement.
DISCUSSION:
Our patient debuted clinically with two immunocomplex phenomena: a rapidly progressive glomerulonephritis and a small vessel vasculitis. Although they have been described in the literature since the middle of the 20th century. They are still rare in clinical practice as initial manifestation.
CONCLUSION:
Membranoproliferative glomerulonephritis and small-vessel vasculitis can present together in infective endocarditis and early and timely diagnosis should be sought.