[Interstitial nephritis with acute renal failure in Ascaris lumbricoides infection]

A girl aged 14 years, 8 months presented with painful swelling of cervical lymph nodes. On frozen section malignancy could be ruled out. There were nonspecific inflammatory changes. In the presence of a prominent eosinophilic reaction the possibility of a drug reaction had been suggested. Because of decreasing renal function, dialysis was started 1 day after lymph node extirpation. A renal biopsy revealed acute interstitial nephritis-again with eosinophils. At this point parasitosis was discussed. There was a slightly elevated titer for filariasis. Shortly thereafter, also eggs of Ascaris lumbricoides were found in the feces. A pulmonary infiltrate made its appearance, with eosinophils in the pleural fluid. About 20 days later, after dialysis and anti-Ascaris therapy, the patient was discharged with no further complaints. Repeated controls revealed no further complaints, especially no more Ascaris lumbricoides. This case had two special aspects: (1) initial presentation with painful cervical lymph node swelling, and (2) subsequent acute renal failure. The literature revealed only four patients with Ascaris lumbricoides infection and acute interstitial nephritis, all described by one author (Zollinger). Perhaps a special hyperergic situation in this patient was responsible for the renal involvement; however, this complication should be watched for in all cases Ascaris lumbricoides infections.