Case Report

Nanobacteria-caused Mitral Valve Calciphylaxis in a Man with Diabetic Renal Failure

Authors: Tomislav M. Jelic, MD, PHD, Amer M. Malas, MD, Samuel S. Groves, MD, Bo Jin, MD, Paul F. Mellen, MD, Garry Osborne, MT, Rod Roque, MT, James G. Rosencrance, MD, Ho-Huang Chang, MD

Abstract

We have found that nanobacteria, recently discovered Gram-negative atypical bacteria, can cause local calciphylaxis on the mitral valve in a setting of high-calcium X phosphorous product in the blood. We present the case of a 33-year-old man with diabetic renal failure on continuous ambulatory peritoneal dialysis who died as a result of multiple brain infarcts due to embolizations from mitral valve vegetations. Systemic calciphylaxis was not present. Spectrometric analysis of the mitral valve vegetations showed that they were composed of calcium phosphate, carbonate apatite form, and fibrin. The electron microscopy of the thrombotic vegetation demonstrated nanobacterium as a nidus for carbonate apatite formation. Investigation for the presence of nanobacteria in the multiple organs involved in systemic calciphylaxis may be of help in elucidating the pathogenesis of this frequently fatal disorder.

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References

1. Budisavljevic MN, Cheek D, Ploth DW. Calciphylaxis in chronic renal failure. J Am Soc Nephrol 1996; 7: 978–982.
 
2. Rosen H, Friedman SA, Raizner AE, et al. Azotemic arteriopathy. Am Heart J 1972; 84: 250–255.
 
3. Kajander EO, Kuronen I, Akerman KK, et al. Nanobacteria from blood: The smallest culturable autonomously replicating agent on Earth. Proc SPIE 1997; 3111: 420–428.
 
4. Kajander EO, Ciftcioglu N. Nanobacteria: An alternative mechanism for pathogenic intra- and extracellular calcification and stone formation. Proc Natl Acad Sci U S A 1998; 95: 8274–8279.
 
5. Abbott A. Battle lines drawn between “nanobacteria” researchers. Nature 1999; 401: 105.
 
6. Ciftcioglu N, Bjorklund M, Kuorikoski K, et al. Nanobacteria: An infectious cause for kidney stone formation. Kidney Int 1999; 56: 1893–1898.
 
7. Hjelle JT, Miller-Hjelle MA, Poxton IR, et al. Endotoxin and nanobacteria in polycystic kidney disease. Kidney Int 2000; 57: 2360–2374.
 
8. Adrogue HJ, Frazier MR, Zeluff B, et al. Systemic calciphylaxis revisited. Am J Nephrol 1981; 1: 177–183.
 
9. Kent RB III, Lyerly RT. Systemic calciphylaxis. South Med J. 1994; 87: 278–281.
 
10. Torok L, Kozepessy L. Cutaneous gangrene due to hyperparathyroidism secondary to chronic renal failure (uraemic gangrene syndrome). Clin Exp Dermatol 1996; 21: 75–77.
 
11. Selye H, Gabbiani G, Strebel R. Sensitization to calciphylaxis by endogenous parathyroid hormone. Endocrinology 1962; 71: 554–558.
 
12. Katsamakis G, Lukovits TG, Gorelick PB. Calcific cerebral embolism in systemic calciphylaxis. Neurology 1998; 51: 295–297.
 
13. Janigan DT, Hirsch DJ, Klassen GA, et al. Calcified subcutaneous arterioles with infarcts of the subcutis and skin (“calciphylaxis”) in chronic renal failure. Am J Kidney Dis 2000; 35: 588–597.
 
14. Fine A, Fleming S, Leslie W. Calciphylaxis presenting with calf pain and plaques in four continuous ambulatory peritoneal dialysis patients and in one predialysis patient. Am J Kidney Dis 1995; 25: 498–502.
 
15. Levin A, Mehta RL, Goldstein MB. Mathematical formulation to help identify the patient at risk of ischemic tissue necrosis- a potentially lethal complication of chronic renal failure. Am J Nephrol 1993; 13: 448–453.
 
16. Stein M, Anderson C, Ricciardi R, et al. Penile gangrene associated with chronic renal failure: Report of 7 cases and review of the literature. J Urol 1994; 152: 2014–2016.
 
17. Machovich R. Effect of calcium phosphate on thrombin and on its sensitivity to heparin and antithrombin-III. Thromb Res 1976; 9: 123–131.