Cephotaxime-Associated Allergic Interstitial Nephritis and Mpo-Anca Positive Vasculitis

Abstract

We report a case of reversible acute renal failure after cefotaxime treatment in a patient affected by non-Hodgkin lymphoma. Renal biopsy showed necrotizing vasculitis associated with eosinophil-rich interstitial inflammatory infiltrates and patchy infiltrates of CD20+ lymphoid cells. High serum p-ANCA titers were also detected. Drug withdrawal was closely related with recovery of renal function and disappearance of ANCA. Acute renal failure therefore represented a consequence of ANCA-mediated renal vasculitis and acute interstitial nephritis related to cefotaxime treatment.

Drug-Induced Glomerular Disease

“…Both isoniazid and rifampin have been implicated as causes of vasculitis in case reports (60,61), but the association between these drugs and AAV is confounded by studies that have shown a high prevalence of positive ANCA serologies in patients with tuberculosis (62). Evidence for the association of other medications and AAV is limited to isolated case reports (63)(64)(65).…”

Rare adverse effect of a common drug: nitrofurantoin-induced ANCA-associated vasculitis

“…It usually occurs within 1–3 weeks after a drug is started. It has been reported in association with antithyroid drugs such as propylthiouracil, methimazole, carbimazole and other drugs including penicillamine,7 hydralazine, minocycline, rifampin, phenytoin, cefotaxime,8 indomethacin9 and clozapine. It is usually associated with high titres of ANCA antibodies with MPO specificity 10.…”

Hypersensitivity vasculitis induced by cefoperazone/sulbactam

“…Urticaria, maculopapular and erythematous rash are more common reactions than other immediate reactions such as anaphylaxis and bronchospasm [1,2,11,12]. Although some anecdotal cases of vasculitis have been reported related with cephotaxim, cefuroxim and cefprozil, cefoperazone has not been reported to cause vasculitic complications before [13-15]. …”