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Kidney Week

Abstract: PO0133

Zosyn Induced Neutrophil-Rich Allergic Interstitial Nephritis: A Rare Case

Session Information

Category: Trainee Case Report

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Bustos, Aulio Elias, Westchester Medical Center Health Network, Valhalla, New York, United States
  • Gupta, Sanjeev, Westchester Medical Center Health Network, Valhalla, New York, United States
  • Chugh, Savneek S., Westchester Medical Center Health Network, Valhalla, New York, United States
  • Becerra rivera, Viviam Isleny, Westchester Medical Center Health Network, Valhalla, New York, United States
  • Mittal, Amol, Westchester Medical Center Health Network, Valhalla, New York, United States
  • Wang, Xiaotong, Westchester Medical Center Health Network, Valhalla, New York, United States
Introduction

Acute interstitial nephritis (AIN) is a clinico-pathological syndrome associated with infections or drugs. AIN is responsible for 1-3% acute kidney injury (AKI) cases. Drug induced-AIN (DI-AIN) rarely presents with the classic triad of rash, fever and eosinophilia, and is usually a diagnosis of exclusion. On renal biopsy (Bx), DI-AIN usually presents with interstitial inflammation rich with eosinophils and plasma cells and, in rare occasions, with neutrophils. Here, we report a Zosyn induce neutrophil-rich AIN case

Case Description

A 40-year-old female with medical history breast cancer came with fever, pain and induration over her left breast. On admission she got Zosyn for suspect breast abscess. Next day, AKI noted, creatinine (Cr) increased from 0.6 to 3.3mg/dL. She remained hemodynamically stable. Laboratories showed no anemia, leukocytosis or peripheral eosinophilia. BUN/Cr of 38/4.7. Urinalysis negative for protein, blood, crystals, casts, white blood cells, red blood cells, nitrites, urine sodium and chloride <20mmol/L, positive urine eosinophils. Negative autoimmune and hepatitis B/C work up. Blood and urine cultures were negative. Renal bladder ultrasound (US) showed normal kidney size with no sign of infection. Breast US findings were concerning for neoplasm. Zosyn was held and prednisone (1mg/kg) was given for suspicious of DI-AIN. Renal Bx was done showing interstitial inflammation rich with neutrophils and neutrophilic cast without glomerular injury. Immunofluorescence with negative IgG, IgA, IgM, C3, C1q, fibrinogen, albumin, kappa and lambda light chains. Electron microscopy was unremarkable. Cr at 3rdday peaked at 4.7mg/dL, then trended down. Upon discharge BUN/Cr39/2.36. One week after at renal clinic visit her kidney function came back to her baseline. We continued steroids for 3 weeks due to suspicion of AIN as repeated renal imaging and urine culture remained negative

Discussion

This is a rare case where Zosyn was promptly stopped and prednisone was initiated early in the course of AIN despite neutrophilic infiltration on renal Bx. DI-AIN can present with predominant neutrophilic infiltration; however, this makes the diagnosis more challenging. High suspicion, prompt antibiotic discontinuation and early institution of steroid can prevent further kidney injury or potential chronic kidney disease