title: Acute tubular necrosis as a part of vancomycin induced drug rash with eosinophilia and systemic symptoms syndrome with coincident postinfectious glomerulonephritis.
abstract: Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially fatal condition characterized by skin rash, fever, eosinophilia, and multiorgan involvement. Various drugs may be associated with this syndrome including carbamazepine, allopurinol, and sulfasalazine. Renal involvement in DRESS syndrome most commonly presents as acute kidney injury due to interstitial nephritis. An 11-year-old boy was referred to the Children's Hospital of Pusan National University because of persistent fever, rash, abdominal distension, generalized edema, lymphadenopathy, and eosinophilia. He previously received vancomycin and ceftriaxone for 10 days at another hospital. He developed acute kidney injury with nephrotic range proteinuria and hypocomplementemia. A subsequent renal biopsy indicated the presence of acute tubular necrosis (ATN) and late exudative phase of postinfectious glomerulonephritis (PIGN). Systemic symptoms and renal function improved with corticosteroid therapy after the discontinuation of vancomycin. Here, we describe a biopsy-proven case of severe ATN that manifested as a part of vancomycin-induced DRESS syndrome with coincident PIGN. It is important for clinicians to be aware of this syndrome due to its severity and potentially fatal nature.
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Kyung Min
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Kyoung
authors.initials: K
authors.lastname: Sung
authors.affiliation: Department of Pediatrics, Pusan National University Hospital, Busan, Korea.
authors.forename: Hea Koung
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Seong Heon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Pusan National University Hospital, Busan, Korea.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Gil Ho
authors.initials: GH
authors.lastname: Ban
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Su Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Hyoung Doo
authors.initials: HD
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
authors.forename: Su Young
authors.initials: SY
authors.lastname: Kim
keywords: Acute kidney injury; Acute kidney tubular necrosis; DRESS syndrome; Postinfectious glomerulonephritis; Vancomycin