The 498th case: rash, fever and hematuria
10.3760/cma.j.cn112138-20210804-00530
- VernacularTitle:第498例——皮疹、发热、肾小球肾炎
- Author:
Shangyi JIN
1
;
Wei CAO
;
Li WANG
;
Mengtao LI
;
Xiaofeng ZENG
;
Nan JIANG
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院风湿免疫科 国家皮肤与免疫疾病临床医学研究中心 疑难重症及罕见病国家重点实验室 风湿免疫病学教育部重点实验室，北京 100730
- Keywords:
Fever;
Connective tissue disease;
Endocarditis, baterial
- From:
Chinese Journal of Internal Medicine
2022;61(8):969-972
- CountryChina
- Language:Chinese
-
Abstract:
A 50-year-old man was admitted to the Department of Rheumatology at Peking Union Medical College Hospital with rash for 6 months, and fever and hematuria for 5 months. The main clinical manifestations included fever, fatigue, purpura, hematuria and thrombocytopenia. He was positive for antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibodies (ANCA) and rheumatoid factor (RF), and had low complement levels. Initial blood culture, echocardiography and chest CT showed no signs of infection. Diagnosis of connective tissue disease was made initially. His disease improved under treatment with glucocorticoids and immunosuppressive agents, but relapsed when glucocorticoids were tapered. After admission, the diagnosis was reconsidered, and infective endocarditis was finally diagnosed with repeated positive blood cultures and vegetations detected by transesophageal echocardiography. Amoxicillin and clavulanate potassium were initiated, and surgery was performed. His symptoms finally recovered gradually.
