A Case Report Of Infective Endocarditis With Glomerulonephritis With Purpura As The First Manifestation And Literature Review

Objective: To summarize the case data of a case of infective endocarditis related glomerulonephritis(IE-related GN)with purpura as the first episode,and review the literature on IE-related GN.In order to improve the understanding of infective endocarditis-associated nephritis,reduce the misdiagnosis and missed diagnosis of such diseases in the clinic.Methods: The clinical and pathological data of a case of infective endocarditis-associated glomerulonephritis with purpura as the first manifestation in the Department of Nephrology,the Third Hospital of Hebei Medical University,was collected.The pathogenic characteristics,susceptibility factors and differential diagnosis were analyzed.,renal injury mechanism,treatment prognosis characteristics and review by consulting domestic and foreign literature.Result: The patient was a middle-aged male,55 years old.The first symptoms were purpura and joint pain in both lower extremities,and severe anemia and elevated serum creatinine gradually appeared.More than 10 years of previous history of hypertension,no regular oral antihypertensive drug treatment,no history of organic heart valve disease.The blood culture is Streptococcus viridans,and the echocardiography of our hospital suggests mitral valve mites.The renal biopsy is consistent with infection-related glomerulonephritis with hypertensive renal damage.The clinical diagnosis is subacute endocarditis,subacute infective endocarditis-associated glomerulonephritis with hypertensive renal damage,and high blood pressure level 3 is at high risk.After 4 weeks of treatment with ceftriaxone against infection,hormones,and blood pressure control,serum creatinine gradually decreased to 124.42 μ mol/L,and the condition improved and was discharged.After 2 months of follow-up,serum complement returned to normal and serum creatinine was maintained at 120 μmol/L.Failure to fully recover may be associated with untimely diagnosis and treatment,and hypertensive kidney damage.Conclusion: It is not uncommon for IE to be characterized by atypical symptoms in clinical practice,but infective endocarditis related glomerulonephritis with skin purpura as the first manifestation is rare.infective endocarditis related glomerulonephritis treatment is still mainly anti-infective,and it can be treated with hormones or immunosuppressants under the premise of infection control.