Acute interstitial nephritis associated with moxifloxacin use

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Moxifloxacin is a widely used fluoroquinolone antibiotic for respiratory infections.
• While generally safe, its potential for adverse renal effects has not been extensively documented.
• Previous literature and manufacturer data did not report nephrotoxicity associated with moxifloxacin prior to this case.

Observation:

• A 68-year-old female developed acute tubulointerstitial nephritis (ATIN) approximately 10 days after completing moxifloxacin therapy.
• Clinical presentation included elevated serum creatinine, leukocyturia, proteinuria, and foaming urine.
• Kidney biopsy confirmed ATIN, suggesting an immune-mediated hypersensitivity reaction.

Findings:

• Treatment with oral corticosteroids (prednisolone) led to gradual restoration of renal function over six months.
• Mild proteinuria persisted despite treatment.
• The exact pathogenesis of drug-induced ATIN remains under investigation, but hypersensitivity is the suspected mechanism.

Implications:

• This case suggests that fluoroquinolones, including moxifloxacin, may possess nephrotoxic potential.
• ATIN is a serious adverse event that can lead to chronic kidney disease or dialysis.
• Clinicians should consider ATIN in the differential diagnosis for patients presenting with systemic symptoms following moxifloxacin treatment.