Drug-Induced Acute Interstitial Nephritis with Surprise Final: A Concealed Suicide

Abstract

Abdominal pain is a common complaint that frequently leads to admission to hospitals in both infants and adults. 1 Since acute abdomen may require surgical intervention, the abdominal pain should be evaluated urgently. Thus, every abdominal pain should be taken into account by medical practitioners in terms of whether there is a surgical emergency or not. Although the most common causes of acute onset abdominal pain in the adolescent group are well-known diseases such as acute gastroenteritis, constipation, systemic respiratory viral illness, and mesenteric lymphadenitis; sometimes the reason is an acute abdomen that will require surgical intervention. 2 In this age group, drug intake and related adverse drug reactions should also be considered. Since teenage patients can concealed their medication intake, drug-related complications can be confused with true acute abdomen. 3 Acute interstitial nephritis (AIN) is also among the lesser-known causes of abdominal pain. It is an immune-mediated type of tubulointerstitial kidney damage that can take place as the result of a secondary or a reactive process; especially as a result of drugs, autoimmune diseases, infections, and some hematological disorders. 4 Tubulointerstitial inflammation was first described by Biermer and was defined as the distinct entity of AIN by Councilman. [5][6][7] Medications are by far the most frequent cause of acute interstitial nephritis. Drugs cause a low but significant dose-independent risk of starting a hypersensitivity reaction that can cause acute interstitial nephritis. Other causes include autoimmune diseases, infections, sarcoidosis, and uveitis. As a result of family conflicts and disagreements, suicide cases due to drug use can be seen in adolescence. Although some suicide cases are known to result in death, most suicide cases especially attempted by female patients, resulting in mild to moderate clinical symptoms. Diagnosis is difficult when adolescent patients conceal their drug intake. A meticulous anamnesis taking and performing a thorough physical examination is crucial to determine the origin of acute abdominal pain