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Cloxacillin-induced acute tubulo interstitial nephritis
R García-Ortiz1, R S Espinoza, G R Silva
1Department of Nephrology, Hospital A. Nef, Faculty of Medicine, Universidad de Valparaíso, Chile.
Objective:
To report a case of possible cloxacillin-induced acute tubulo interstitial nephritis (AIN).
Case Summary:
A 15-year-old male patient presented with hypertension, edema, lumbar pain, sterile pyuria, eosinophiluria (ten percent), and severe renal dysfunction three months after the ingestion of cloxacillin. A renal biopsy revealed diffuse edema and inflammatory infiltrate of the interstitium (five percent eosinophils). He received four sessions of peritoneal dialysis with dramatic improvement in urinary output and renal function. His biochemical parameters returned to normal values 21 days after admission, without the use of glucocorticosteroids.
Discussion:
Published case reports on AIN induced by penicillin and related drugs are reviewed and compared. The role of interstitial edema in acute renal failure associated with drug-induced AIN is mentioned.
Conclusions:
AIN is a rare but significant complication of therapy with penicillin and related drugs. The clinical picture is similar for all of these drugs, but skin rash and fever are absent in AIN induced by cloxacillin and cloxacillin-related drugs. Dialysis improved the patient's urinary output and renal function. Beta-lactam antibiotics should be avoided in patients with cloxacillin-induced AIN.
Insights
Cloxacillin can cause acute tubulointerstitial nephritis (AIN), a rare kidney condition. Prompt dialysis improved renal function in a teenage patient, highlighting the need to avoid beta-lactam antibiotics in such cases.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Acute tubulointerstitial nephritis (AIN) is an inflammatory kidney condition.
- Penicillin and related antibiotics are known, though rare, causes of AIN.
- Cloxacillin-induced AIN presents unique clinical features compared to other beta-lactam-induced AIN.
Observation:
- A 15-year-old male developed severe renal dysfunction, hypertension, edema, and lumbar pain after cloxacillin use.
- Laboratory findings included sterile pyuria and significant eosinophiluria (10%).
- Renal biopsy confirmed interstitial edema and inflammatory infiltrate with eosinophils (5%).
Findings:
- Peritoneal dialysis led to rapid improvement in urinary output and renal function.
- Biochemical parameters normalized within 21 days without glucocorticosteroid treatment.
- AIN induced by cloxacillin may lack typical symptoms like fever and rash.
Implications:
- This case underscores the importance of considering cloxacillin as a potential cause of AIN.
- Early recognition and management, including dialysis, can reverse acute kidney injury.
- Avoiding beta-lactam antibiotics is crucial for patients with a history of cloxacillin-induced AIN.