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Vancomycin-induced acute interstitial nephritis
1Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.
Objective:
To report a case of acute interstitial nephritis (AIN) related to administration of vancomycin for the treatment of Staphylococcus aureus sternal wound infection, osteomyelitis, and infective endocarditis.
Case Summary:
Reports in the literature regarding vancomycin-induced AIN are scarce. We describe the fifth known case of AIN, in a 64-year-old white man who developed fever, maculopapular rash, acute renal failure, eosinophilia, and eosinophiluria after approximately 1 month of vancomycin treatment. The results of the renal biopsy were consistent with an allergic drug reaction. Four months after his initial episode of AIN, the patient was rechallenged with vancomycin for the treatment of S. aureus septic arthritis. One day after initiation of vancomycin, serum eosinophils started to rise, his urine tested positive for eosinophils, but his serum creatinine remained stable.
Conclusions:
Our case report and others from the literature suggest vancomycin causes allergic AIN. Clinicians should be aware of this adverse effect in an era of increasing use of vancomycin for treatment of resistant gram-positive organisms.
Insights
Vancomycin can cause acute interstitial nephritis (AIN), an allergic kidney reaction. This adverse effect is important for clinicians to recognize, especially with increasing vancomycin use for resistant infections.
Area of Science:
- Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Vancomycin is frequently used for serious Gram-positive bacterial infections.
- Acute interstitial nephritis (AIN) is a potential adverse drug reaction.
- Literature on vancomycin-induced AIN is limited.
Observation:
- A 64-year-old male developed fever, rash, acute renal failure, eosinophilia, and eosinophiluria after one month of vancomycin.
- Renal biopsy confirmed an allergic drug reaction consistent with AIN.
- Upon rechallenge with vancomycin, the patient exhibited rising eosinophils and eosinophiluria, but stable renal function.
Findings:
- Vancomycin administration was linked to acute interstitial nephritis (AIN).
- The patient's presentation and biopsy results were indicative of an allergic drug reaction.
- Rechallenge confirmed a hypersensitivity response to vancomycin.
Implications:
- Clinicians must consider vancomycin as a potential cause of AIN.
- Increased vigilance is necessary given the rising use of vancomycin for resistant infections.
- Early recognition and discontinuation of vancomycin may prevent severe renal outcomes.