Immune complexes endocarditis

Osier s node Raised, painful, red lesions found on the finger pulps and soles of the feet indicative of subacute bacterial endocarditis. Osier s nodes are caused by immune complex deposition. 

The extravalvular manifestations of infective endocarditis have many clinical features of an immune complex disease and immunologic studies of... 

C7. Carson, D. A., Bayer, A. S., Eisenberg, R. A., Lawrence, S., andTheofilopoulos, A. N., IgG rheumatoid factor in subacute bacterial endocarditis Relationship to IgM rheumatoid factor and circulating immune complexes. Clin. Exp. Immunol. 31, 100-103... 

Adverse effects are in general uncommon, apart from allergy (above). It is salutary to reflect that the first clinically useful true antibiotic (1942) is still in use and is also amongst the least toxic. Only in patients with bacterial endocarditis, where the requirement for high doses can co-exist with reduced clearance due to immune complex glomerulonephritis, does a risk of dose related toxicity (convulsions) arise. 

A 59-year-old man, who had taken amiodarone 200 mg/day for 2 years, developed fever, pleuritic chest pain, dyspnea at rest, a non-productive cough, malaise, and joint pains (211). He had a verrucous endocarditis and a pleuropericardial effusion. He had raised titers of antinuclear antibodies (1 320) with anti-Ro specificity. Serum complement was normal and there were no circulating immune complexes, no cryoglobulins, and no anti-dsDNA, anti-La, anti-Ul ribonucleoprotein, anti-Sm, anti-Scl, 70, anti-Jo 1, antihistone, antiphosphohpid, anticentromere, anticardioli-pin, or anticytoplasmic antibodies. Within 7 days of withdrawal of amiodarone the signs and symptoms started to resolve, and he recovered fuUy with the addition of prednisolone. 

Other causes of acute nephritis are reactions to drugs, acute infection of the kidneys, systemic diseases with immune complexes such as SLE, bacterial endocarditis, and finally disease in which the antigen is unknown but possibly related to antecedent viral infections. 

Osier s nodes—Osier s nodes are red, raised tender nodules usually 5 mm in diameter on the pulps of toes or fingers. Seen in patients with endocarditis, they are thought to be due to the deposition of immune complexes. 

Serum complement levels are useful to distinguish between various forms of acute nephritis that may be due to either a primary renal disorder or a systemic disease. Glomerular diseases associated with decreased complement levels include systemic diseases such as systemic lupus erythematosus, subacute bacterial endocarditis, and cryoglobulinemia, and renal diseases such as acute poststreptococcal glomerulonephritis. Glomerular diseases in which serum complement levels are normal include systemic diseases such as Goodpasture s syndrome and renal diseases such as IgG-IgA nephropathy, antiglomerular basement membrane disease, and immune-complex disease. 

Associations of several autoimmune diseases with atherosclerosis have been observed and a role for LDL oxidation especially in systemic lupus erythematosus (SLE) has been suggested (Frostegard et al. 2005 Hayem et al. 2001 Svenungsson et al. 2001). OxLDL forms immune complexes with p2GPI, which can be detected in the plasma of patients. OxLDL/p2GPI complexes have been demonstrated in patients with syphilis, infectious endocarditis, diabetes melli-tus, antiphospholipid syndrome and chronic nephritis, indicating that oxidation of LDL and the formation of complexes with p2GPI is not restricted to SLE. It is hypothesized that these autoantibodies accelerate the development of atherosclerosis in autoimmune patients. 

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