Vancomycin-induced acute interstitial nephritis.
OBJECTIVE
To report a case of acute interstitial nephritis (AIN) related to administration of vancomycin for the treatment of Staphylococcus aureus sternal wound infection, osteomyelitis, and infective endocarditis.


METHODS
Reports in the literature regarding vancomycin-induced AIN are scarce. We describe the fifth known case of AIN, in a 64-year-old white man who developed fever, maculopapular rash, acute renal failure, eosinophilia, and eosinophiluria after approximately 1 month of vancomycin treatment. The results of the renal biopsy were consistent with an allergic drug reaction. Four months after his initial episode of AIN, the patient was rechallenged with vancomycin for the treatment of S. aureus septic arthritis. One day after initiation of vancomycin, serum eosinophils started to rise, his urine tested positive for eosinophils, but his serum creatinine remained stable.


CONCLUSIONS
Our case report and others from the literature suggest vancomycin causes allergic AIN. Clinicians should be aware of this adverse effect in an era of increasing use of vancomycin for treatment of resistant gram-positive organisms.
Wai
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Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.
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D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000150:complications; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D013530:Surgical Wound Infection / Q000150:complications / Q000188:drug therapy; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin