Table 5.

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

Patient	Age	Sex	Race	Other Comorbidities	Site of Infection	Staph Strain	Blood Culture	Culture from Site of Infection	ANCA Serology	Urine Protein	Crescents	IgG	IgA	C3	Deposits on Ultrastructural Examination	S. cr. and Duration after Biopsy
1	22	M	W	IVDU, Hepatitis C	endocarditis, septic emboli to lung, paraspinal abscess	MRSA	positive	not done	C-ANCA 1:160; PR3 ELISA positive	3.2 g/d	present, diffuse	weak	weak	weak	absent	Recovered. S. cr. 1.8 mg/dl 2 mo
2	57	M	W	aortic valve replacement	endocarditis	MSSE	positive	not done	C-ANCA 1:40, PR3 ELISA positive, pulmonary hemorrhage	>300 mg/dl	present, focal	0	weak	2+	rare small mesangial deposits “pauci-immune” pattern	expired 1 wk after biopsy
3	31	F	W	IVDU, bipolar disorder	bacteremia	MRSA	positive	absent	P-ANCA positive, titer not known; ELISA not performed	31 mg/dl	present, focal necrotizing lesion	2+	0	3+	numerous mesangial, intramembranous, subepithelial humps	lost to follow-up
4	52	M	W	Hepatitis C, cirrhosis	bacteremia	MRSA	positive	absent	C-ANCA 1:20, PR3 and MPO ELISA negative	2.2 g/d	absent	1+	2+	2+	mesangial, no humps	S. cr. 4.1, 15 d after biopsy. No recovery
5	61	M	W	Hepatitis C, liver cirrhosis	bacteremia	MSSA	positive	not done	P-ANCA 1:80, PR3 ELISA positive	499 mg/d	absent	3+	3+	2+	mesangial, no humps	S. cr. 0.75 after 4 mo. Recovered
6	49	M	W	Abdominal surgery, enterocutaneous fistula, TPN, PICC line in place	PICC line infection with bacteremia	MSSA	positive	positive	C-ANCA and P-ANCA negative; PR3 ELISA positive	902 mg/d	absent	weak	2+	1+	mesangial, no humps	S.cr. 0.8, 21 d after biopsy. Recovered
7	37	M	W	Hep B, Hep C, IVDU, bipolar disorder	skin infection and cellulitis	MSSA	negative	positive	C-ANCA and P-ANCA negative; PR3 ELISA positive	564 mg/dl	absent	weak	1+	2+	mesangial, no humps	S. cr. 0.9, 2 mo after biopsy, recovered
8	38	M	W	IVDU, Hepatitis C	foot osteomyelitis, pulmonary septic emboli, sepsis	MRSA	positive	positive	P-ANCA 1:160, MPO and PR3 ELISA negative	6 g/d	present, focal fibrocellular	0	1+	2+	mesangial with subepithelial humps	S. cr. 1.9 22 days after biopsy (off dialysis recovered).
9	37	F	W	IVDU	Psoas muscle abscess and osteomyelitis in the spine	MRSA	positive	positive	C-ANCA 1:80; PR3 and MPO ELISA negative; pulmonary hemorrhage	oliguric	absent	weak	1+	1+	few mesangial, no humps	S. 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.