Key result
Low-dose corticosteroids plus antibiotics linked to renal recovery and fever resolution in infective endocarditis-induced RPGN.
Why the study?
The optimal therapy for infective endocarditis associated with renal injury is not adequately defined.
Does short-term low-dose corticosteroid therapy combined with antibiotics improve renal function in a patient with infective endocarditis-induced rapidly progressive glomerulonephritis?
Case Report (n=1)
No
Does short-term low-dose corticosteroid therapy combined with antibiotics improve renal function in a patient with infective endocarditis-induced rapidly progressive glomerulonephritis?
Short-term, low-dose corticosteroid therapy combined with antibiotics may successfully treat rapidly progressive glomerulonephritis associated with infective endocarditis.
BACKGROUND: The mortality rate among patients with infective endocarditis, especially associated with the presence of complications or coexisting conditions such as renal failure and the use of combined medical and surgical therapy remains still high. Prolonged parenteral administration of a bactericidal antimicrobial agent or combination of agents is usually recommended, however, the optimal therapy for infective endocarditis associated with renal injury is not adequately defined. CASE PRESENTATION: Patient was a 24-years old man who presented to our hospital with fever, fatigue, and rapidly progressive glomerulonephritis. He had a history of ventricular septum defect (VSD). A renal biopsy specimen revealed crescentic glomerulonephritis and echocardiogram revealed VSD with vegetation on the tricuspid valve. Specimens of blood demonstrated Propionibacterium Acnes. The intensive antibiotic therapy with penicillin G was started without clinical improvement of renal function or resolution of fever over the next 7 days. After the short-term treatment of low dose of corticosteroid combined with continuous antibiotics, high fever and renal insufficiency were dramatically improved. CONCLUSION: Although renal function in our case worsened despite therapy with antibiotics, a short-term and low dose of corticosteroid therapy with antibiotics was able to recover renal function and the patient finally underwent tricuspid valve-plasty and VSD closure. We suggest that the patients with rapidly progressive glomerulonephritis associated with infective endocarditis might be treated with a short-term and low dose of corticosteroid successfully.
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Koya et al. (2004) conducted a case report in Infective endocarditis-induced rapidly progressive glomerulonephritis (n=1). Short-term low-dose corticosteroid combined with antibiotics vs. Antibiotics alone (initial phase) was evaluated on Recovery of renal function and resolution of fever. Short-term, low-dose corticosteroid therapy combined with antibiotics successfully recovered renal function and resolved high fever in a patient with infective endocarditis-induced rapidly progressive glomerulonephritis.
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