title: Intravascular foscarnet crystal precipitation causing multiorgan failure.
abstract: We report a case of multiorgan failure resulting from treatment with the antiviral foscarnet in a kidney transplant recipient. Precipitation of foscarnet crystals was confirmed histologically from a biopsy of the transplant using optical and infrared microscopy. In addition to kidney damage resulting from foscarnet crystal precipitation in the tubular lumen and glomerular capillaries, the patient presented with pancreatitis, pancolitis, and myocarditis with shock. Interruption of the treatment led to rapid improvement in her general condition, but did not prevent permanent loss of the kidney transplant. When faced with unexplained multiorgan failure in a patient treated with foscarnet, one should assume this substance to be toxic. A kidney biopsy can confirm this diagnosis.
authors.affiliation: Nephrology Department, Tenon Hospital, AP-HP, Paris; Nephrology Department, Clermont Ferrand, University Hospital, Clermont-Ferrand, Paris, France; Faculty of Medicine, University Clermont 1, Clermont-Ferrand, Paris, France. Electronic address: cphilipponnet@chu-clermontferrand.fr.
authors.forename: Carole
authors.initials: C
authors.lastname: Philipponnet
authors.affiliation: Nephrology Department, Tenon Hospital, AP-HP, Paris.
authors.forename: Pierre-Antoine
authors.initials: PA
authors.lastname: Michel
authors.affiliation: Physiology and Anatomy, Tenon Hospital, AP-HP, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Daudon
authors.affiliation: Pathology Departments, Tenon Hospital, AP-HP, Paris, France; Sorbonne Universities, UPMC, Paris 06 University, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brocheriou
authors.affiliation: Nephrology Department, Tenon Hospital, AP-HP, Paris; Sorbonne Universities, UPMC, Paris 06 University, Paris, France; INSERM, UPMC, Paris 06 University, Paris, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Boffa
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D001706:Biopsy; D011232:Chemical Precipitation; D003460:Crystallization; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D017245:Foscarnet / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet
keywords: Foscarnet crystal; drug crystal; drug-induced renal failure; multiorgan failure; renal failure