Table 5.

Nine patients with Staphylococcus infection–associated GN and positive ANCA serology

PatientAgeSexRaceOther ComorbiditiesSite of InfectionStaph StrainBlood CultureCulture from Site of InfectionANCA SerologyUrine ProteinCrescentsIgGIgAC3Deposits on Ultrastructural ExaminationS. cr. and Duration after Biopsy
122MWIVDU, Hepatitis Cendocarditis, septic emboli to lung, paraspinal abscessMRSApositivenot doneC-ANCA 1:160; PR3 ELISA positive3.2 g/dpresent, diffuseweakweakweakabsentRecovered. S. cr. 1.8 mg/dl 2 mo
257MWaortic valve replacementendocarditisMSSEpositivenot doneC-ANCA 1:40, PR3 ELISA positive, pulmonary hemorrhage>300 mg/dlpresent, focal0weak2+rare small mesangial deposits “pauci-immune” patternexpired 1 wk after biopsy
331FWIVDU, bipolar disorderbacteremiaMRSApositiveabsentP-ANCA positive, titer not known; ELISA not performed31 mg/dlpresent, focal necrotizing lesion2+03+numerous mesangial, intramembranous, subepithelial humpslost to follow-up
452MWHepatitis C, cirrhosisbacteremiaMRSApositiveabsentC-ANCA 1:20, PR3 and MPO ELISA negative2.2 g/dabsent1+2+2+mesangial, no humpsS. cr. 4.1, 15 d after biopsy. No recovery
561MWHepatitis C, liver cirrhosisbacteremiaMSSApositivenot doneP-ANCA 1:80, PR3 ELISA positive499 mg/dabsent3+3+2+mesangial, no humpsS. cr. 0.75 after 4 mo. Recovered
649MWAbdominal surgery, enterocutaneous fistula, TPN, PICC line in placePICC line infection with bacteremiaMSSApositivepositiveC-ANCA and P-ANCA negative; PR3 ELISA positive902 mg/dabsentweak2+1+mesangial, no humpsS.cr. 0.8, 21 d after biopsy. Recovered
737MWHep B, Hep C, IVDU, bipolar disorderskin infection and cellulitisMSSAnegativepositiveC-ANCA and P-ANCA negative; PR3 ELISA positive564 mg/dlabsentweak1+2+mesangial, no humpsS. cr. 0.9, 2 mo after biopsy, recovered
838MWIVDU, Hepatitis Cfoot osteomyelitis, pulmonary septic emboli, sepsisMRSApositivepositiveP-ANCA 1:160, MPO and PR3 ELISA negative6 g/dpresent, focal fibrocellular01+2+mesangial with subepithelial humpsS. cr. 1.9 22 days after biopsy (off dialysis recovered).
937FWIVDUPsoas muscle abscess and osteomyelitis in the spineMRSApositivepositiveC-ANCA 1:80; PR3 and MPO ELISA negative; pulmonary hemorrhageoliguricabsentweak1+1+few mesangial, no humpsS. cr. 6, remains on dialysis 4 mo after biopsy
  • ANCA was detected by indirect immunofluorescence using sera at 1:20 dilution, followed by serial dilutions if screen was positive. MPO and PR3 were detected by ELISA, but were only reported as positive or negative. S. cr., serum creatinine; W, white; IVDU, intravenous drug use; MRSA, methicillin-resistant Staphylococcus aureus; C-ANCA, cytoplasmic ANCA; PR3, anti–proteinase 3; MSSE, methicillin-sensitive Staphylococcus aureus; P-ANCA, perinuclear ANCA; TPN, total parental nutrition; PICC, peripherally-inserted central catheter; Hep B, Hepatitis B; Hep C, Hepatitis C; MPO, myeloperoxidase.