Biopsy proven acute interstitial nephritis after treatment with moxifloxacin.
BACKGROUND
Acute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury. At least 70% of AIN is caused by various drugs, mainly penicillins and non-steroidal anti-inflammatory drugs. Quinolones are only rarely known to cause AIN and so far cases have been mainly described with older fluoroquinolones.


METHODS
Here we describe a case of biopsy proven interstitial nephritis after moxifloxacin treatment. The patient presented with fever, rigors and dialysis dependent acute kidney injury, just a few days after treatment of a respiratory tract infection with moxifloxacin. The renal biopsy revealed dense infiltrates mainly composed of eosinophils and severe interstitial edema. A course of oral prednisolone (1 mg/kg/day) was commenced and rapidly tapered to zero within three weeks. The renal function improved, and the patient was discharged with a creatinine of 107 micromol/l.


CONCLUSIONS
This case illustrates that pharmacovigilance is important to early detect rare side effects, such as AIN, even in drugs with a favourable risk/benefit ratio such as moxifloxacin.
Chatzikyrkou
Christos
C
Department of Nephrology and Hypertension, Institute of Pathology, Medical School Hannover, Hannover, Germany. chatzikyrkou.christos@mh-hannover.de
Hamwi
Iyas
I
Clajus
Christian
C
Becker
Jan
J
Hafer
Carsten
C
Kielstein
Jan T
JT
D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001372:Aza Compounds / Q000009:adverse effects*; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000601:surgery; D003404:Creatinine / Q000097:blood; D004487:Edema / Q000139:chemically induced / Q000473:pathology; D004802:Eosinophilia / Q000139:chemically induced / Q000473:pathology; D024841:Fluoroquinolones; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D000077266:Moxifloxacin; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000473:pathology; D011013:Pneumonectomy; D011014:Pneumonia / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D011804:Quinolines / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D011239:Prednisolone; D003404:Creatinine; D000077266:Moxifloxacin