Abstract: PUB013
AKI in a Patient with Erythema Elevatum Diutinum
Session Information
Category: Trainee Case Report
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Sarkar, Mrinalini, University of California Los Angeles, Los Angeles, California, United States
Introduction
Erythema elevatum diutinum (EDD) is a rare cutaneous small vessel vasculitis with dapsone being the drug of choice. .EED has been associated with hematological disorders, autoimmune diseases and cancer in <5% of cases. Drug-induced acute interstitial nephritis (DI-AIN) represents 20% of patients with unexplained AKI.The classic triad of rash, fever, and eosinophilia occurs in <10% of patients, and onset may be delayed by weeks or months after drug initiation
Case Description
55-year-old male with history of EDD admitted for infected lower extremity lesions Vital signs and remainder of physical exam was normal. Patient was on dapsone in the past for over 10 years, however in the last 6months was not taking any medications. Vancomycin, zosyn and dapsone 200mg BID were started on admission. By day 3 only dapsone was continued as imaging was without evidence of deep infection. On day 4 he developed AKI, creatinine (Crt) 4.44mg/dL from 0.7mg/dL on admission. Labs also included Hb of 8.8g/dL, WBC 9.2 k/uL with 5% eosinophils, ESR 118mm/hr. Urinalysis with 3 wbc/hpf, UPCR of 0.18 and urine microscopy showed 1-2 WBC casts/LPF. Serum immunofixation revealed IgA-kappa in the beta region and a faint IgA-kappa monoclonal protein in the gamma region. Autoimmune and infectious serologic work-up negative. Dapsone was stopped on day 5 and renal biopsy was performed due to ongoing rise in Crt on day 8.
Biopsy confirmed diffuse active interstitial nephritis with prominent eosinophilic inflammation along with low grade membranous nephropathy favoring secondary, PLA2R negative. Patient started on IV solumedrol followed by oral prednisone taper over 6 weeks. Creatinine improved to 1mg/dL at 3 month follow-up.
Discussion
DI-AIN was attributed to dapsone. Despite withholding this medication, the Crt continued to rise prompting renal biopsy. Studies suggest that early corticosteroid initiation is associated with better outcomes and be considered in patients with no prior kidney dysfunction. In patients with suspected DI-AIN where a biopsy cannot be performed, a trial of empiric steroid therapy may be considered. The finding of secondary membranous nephropathy (MN) was unexpected as to date there has not been any reports of renal disease and EDD. We report a case of secondary MN in a patient with EDD now undergoing a full malignancy investigation.