Ciprofloxacin-induced granulomatous interstitial nephritis and localized elastolysis

Area of Science:

• Nephrology
• Dermatology
• Pathology

Background:

• Ciprofloxacin is a fluoroquinolone antibiotic commonly used for bacterial infections.
• Acute interstitial nephritis is a known adverse effect of ciprofloxacin.
• Localized elastolysis is a rare condition affecting connective tissue.

Observation:

• A patient developed acute renal failure and distinctive skin lesions after a 14-day course of ciprofloxacin for cellulitis.
• Renal biopsy showed granulomatous interstitial nephritis.
• Skin biopsy revealed elastolysis with histiocytic infiltration and calcification.

Findings:

• This case represents the first documented instance of ciprofloxacin-induced granulomatous interstitial nephritis and localized elastolysis.
• Discontinuation of ciprofloxacin and short-term steroid therapy led to rapid improvement in renal function and skin lesions.
• The patient experienced a relapse of nephritis upon steroid withdrawal, responding again to a second course of steroids.

Implications:

• Ciprofloxacin, similar to penicillin, can induce granulomatous interstitial nephritis and elastolysis.
• Prolonged corticosteroid therapy may be necessary to manage ciprofloxacin-induced granulomatous interstitial nephritis and prevent relapses.
• This case highlights the importance of considering rare drug-induced conditions in patients presenting with renal and dermatological symptoms.