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Abstract: TH-PO560

Anaplasmosis Induced Acute Interstitial Nephritis (AIN) Following Tick Bite: A Rare Association

Session Information

  • Trainee Case Reports - I
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Khan, Neelofar R., Hofstra Northwell School of Medicine, Great Neck, New York, United States
  • Hasan, Alia, Northwell Health, Briarwood, New York, United States
  • Bijol, Vanesa, Northwell Health Hofstra University, Lake Success, New York, United States
  • Jhaveri, Kenar D., Northwell Health Sys, Great Neck, New York, United States
  • Uppal, Nupur N., Hofstra Northwell School of Medicine, Great Neck, New York, United States
Introduction

AIN usually results from immune mediated tubulointerstitial injury initiated by medications and infections.We present a rare case of kidney biopsy proven AIN associated with Anaplasmosis following a tick bite.

Case Description

82 year old Caucasian woman with HTN,HLD presented with fever,tremors,myalgia and fatigue following a camping trip in Catskills where had significant outdoor exposure to the woods. She was found to have AKI,thrombocytopenia and transaminitis.She had serum creatinine(Scr) of 6.62 on admission which peaked at 6.78 during hospitalization.Four months prior, her Scr was 0.9.She denied use of herbal supplements or antibiotics, however had used NSAIDs in the week before hospitalization.Urinalysis showed microscopic hematuria with 10-25 RBCs. Kidney ultrasound was negative for obstructive uropathy. Serological work up for glomerulonephritis was negative.Peripheral smear showed intracellular inclusions suggestive of morulae concerning for Anaplasmosis, and she was initiated on treatment with Doxycycline.Kidney biopsy was performed that revealed moderate AIN, along with 13% glomerulosclerosis,10% interstitial fibrosis and tubular atrophy,and severe arterial and arteriolar sclerosis.AKI, transaminitis and thrombocytopenia started improving with initiation of Doxycycline.She did not require corticosteroid therapy.Although a tick was not noticed specifically, and work up including Anaplasma antibody, Ehrlicia PCR and Lyme’s titres were negative, she was continued on treatment for Anaplasmosis due to high clinical suspicion of the disease. She completed 10 day course of Doxycycline. AKI resolved and Scr decreased to 1.16mg/dl 5 weeks after initial presentation.

Discussion

AIN mediated by various systemic bacterial, viral and parasitic infections is well known. However, association of AIN following anaplasmosis from a tick bite has not been well documented in the literature.To our knowledge, we report the first case of AIN in association with Anaplasmosis.Nephrologists, Infectious disease specialists and Internists should to be aware of this rare cause of AIN.Corticosteroids have no role in infection associated AIN as they are contraindicated in setting of active infection.AKI usually is reversible as infection is treated.Our patient regained baseline kidney function with antimicrobial therapy.