Biopsy proven acute interstitial nephritis after treatment with moxifloxacin

Abstract

BackgroundAcute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury. At least 70% of AIN is caused by various drugs, mainly penicillines and non-steroidal anti-inflammatory drugs. Quinolones are only rarely known to cause AIN and so far cases have been mainly described with older fluoroquinolones.Case PresentationHere we describe a case of biopsy proven interstitial nephritis after moxifloxacin treatment. The patient presented with fever, rigors and dialysis dependent acute kidney injury, just a few days after treatment of a respiratory tract infection with moxifloxacin. The renal biopsy revealed dense infiltrates mainly composed of eosinophils and severe interstitial edema. A course of oral prednisolone (1 mg/kg/day) was commenced and rapidly tapered to zero within three weeks. The renal function improved, and the patient was discharged with a creatinine of 107 μmol/l.ConclusionThis case illustrates that pharmacovigilance is important to early detect rare side effects, such as AIN, even in drugs with a favourable risk/benefit ratio such as moxifloxacin.

Oral penicillin‐associated acute kidney injury in an infant with acute pyelonephritis

“…The characteristic clinical presentation and the presence of a significant number of eosinophils in the interstitial infiltrate points to the diagnosis of drug‐induced ATIN. The present patient was not treated with other drugs known to cause ATIN, apart from penicillin V. Although ATIN has been associated with various antibiotics, including beta‐lactams, quinolones and rifampicin, penicillins are rarely the cause . There is a report of parenteral penicillin G‐ and methicillin‐induced ATIN in adult patients .…”

Aceclofenac-induced acute tubulointerstitial nephritis in a patient with diabetes

“…Of all the aetiologies recognised, the most frequent cause of ATIN is drug-induced and is thought to underlie 60–70% of all cases of AINs 3. Drugs are increasingly implicated as aetiological factors in ATIN because of their increased usage worldwide, increased recognition of characteristic features of ATIN and diagnostic confirmation on renal biopsy.…”

Acute Tubulointerstitial Nephritis in Clinical Oncology: A Comprehensive Review

“…They receive specific anticancer therapy, together with a myriad of drugs to treat symptoms or complications associated with neoplasms. Some of these drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs) [ 7 ], proton pump inhibitors [ 8 ] (PPIs), or antibiotics [ 9 , 10 ], often used in combination, have been described as a trigger for the development of ATIN.…”