SHM Converge Scientific Abstract ePoster Gallery-Autoimmune Vasculitis and Glomerulonephritis Triggered by Infective Endocarditis: A Success Story of Steroids Following Iv Antibiotics and Valve Repair.

Autoimmune Vasculitis and Glomerulonephritis Triggered by Infective Endocarditis: A Success Story of Steroids Following Iv Antibiotics and Valve Repair.

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This case describes a 71-year-old man with infective endocarditis caused by viridans streptococci (Strep mitis/oralis) that was complicated by systemic inflammatory findings, leukocytoclastic vasculitis, and post-infectious glomerulonephritis. He initially presented in August 2021 with anemia, fatigue, and significant weight loss, which led to a broad workup including malignancy evaluation and testing for hemophagocytic lymphohistiocytosis (HLH). Imaging and cardiac evaluation revealed severe aortic and mitral valve disease consistent with endocarditis.<br /><br />His course became further complicated by worsening kidney function, progressing from creatinine 1.5 to 5, and he ultimately required hemodialysis. Renal biopsy confirmed post-infectious glomerulonephritis. Because active infection was still being treated, steroids were initially withheld due to concern for worsening the infection. He received prolonged IV ceftriaxone for three months and also underwent CABG after developing atrial fibrillation with rapid ventricular response, chest pain, and left main coronary stenosis.<br /><br />Once infection control was better established, IV solumedrol was started for the glomerulonephritis while antibiotics continued. After steroid treatment, the patient’s renal function improved significantly and he no longer required dialysis. He was discharged home in early October 2021.<br /><br />The case highlights the diagnostic and treatment challenges of infective endocarditis complicated by autoimmune-like vasculitis and glomerulonephritis. It emphasizes the need to rule out infection before starting immunosuppression and shows that carefully timed steroid therapy may be beneficial in selected patients, although outcomes can vary and there are no clear treatment guidelines for these complicated cases.

Asset Subtitle

Xianghui Zou

Meta Tag

Author List Andrew Lowell, Dennis T. Roarke, Eileen Kim, Gregory Hsu, Mark Patrick Cubillan, Tarif Anzum, Xianghui Zou

Category Clinical Vignettes

Concept Infective Endocarditis

Concept Prolonged Intravenous Antibiotics

Concept Vasculitis

Concept Glomerulonephritis

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization North Shore University Hospital / Long Island Jewish Hospital

Presenting Author Xianghui Zou

Track Adult

Keywords

infective endocarditis

viridans streptococci

Strep mitis/oralis

leukocytoclastic vasculitis

post-infectious glomerulonephritis

aortic and mitral valve disease

hemodialysis

ceftriaxone

steroid therapy

cardiorenal complications

Infective Endocarditis

Prolonged Intravenous Antibiotics

Vasculitis

Glomerulonephritis

Blood Culture